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Description: Co-host Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and co-host Holly Knotowicz, a speech-language pathologist living with EoE, who serves on APFED's Health Sciences Advisory Council, speak with Dr. Amanda Muir, an Assistant Professor of Pediatrics at the Children's Hospital of Philadelphia. In this episode, Ryan and Holly interview Dr. Muir about tissue remodeling and eosinophilic esophagitis (EoE). Dr. Muir describes remodeling and stiffening, its effects, and how it relates to treatment and inflammation.   Listen in for information on remodeling and a pediatric study Dr. Muir is planning. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:48] Co-host Ryan Piansky welcomes co-host Holly Knotowicz. Holly introduces Dr. Amanda Muir, an Assistant Professor of Pediatrics at the Children's Hospital of Philadelphia (CHOP). She has a translational lab that investigates esophageal remodeling in the setting of EoE. Holly thanks Dr. Muir for joining us today.   [1:51] Dr. Muir became interested in eosinophilic disorders as a GI Fellow. There were so many patients with eosinophilic esophagitis and eosinophilic gastrointestinal diseases but there weren't many good therapies and little was known about the long-term results for children. [2:24] Dr. Muir's first eosinophilic interest was eosinophilic esophagitis. She joined a lab that was looking at how the esophagus changes over time in the setting of inflammation. After being in the lab, training, and learning all the skills and techniques, she was able to launch her career and lab.   [2:46] Dr. Muir started her own EoE clinic at CHOP (Children's Hospital of Philadelphia) as part of their Center for Pediatric Eosinophilic Disorders. She sees patients at the clinic, then she can bring questions from the clinic to the lab and talk about them as a group.   [3:28] Dr. Muir explains esophageal remodeling. There is remodeling that happens in the epithelial compartment of the esophagus. Then there's remodeling that happens underneath the surface in the lamina propria. For the most part, when people talk about remodeling in eosinophilic esophagitis, they refer to the remodeling happening below the surface.   [3:50] There is a burgeoning field dedicated to studying the surface of the esophagus, and Dr. Muir is also very interested in that. For today's purposes, we are talking about the remodeling that happens under the surface.   [4:03] Eosinophils that get to the esophagus secrete chemicals that excite the cells below the surface to secrete collagen. Collagen is the glue that holds the body together. They're secreting glue to help the esophagus hold together, and the esophagus gets stiffer and stiffer, over time. That is remodeling. It's the body trying to heal itself.   [5:04] Are children and adults equally at risk for remodeling? Patients develop a stiffening of the esophagus more, later in life. It is thought that the more years you have this inflammation, the more stiff your esophagus gets. There are patients six to nine years old who already have signs of stiffening.   [5:28] Dr. Calies Menard-Katcher from Colorado published a paper where she described all of the eosinophilic esophagitis patients at her institution who got dilated. Dilation is the process of a balloon stretching your esophagus open when it's too narrow. She had patients as young as six in her cohort that she described as having EoE strictures.   [5:49] Remodeling happens with younger patients but we're not as good at finding it.   [6:08] Any type of inflammation in the GI tract can lead to some stiffening. The typical gastrointestinal disease that we think of as remodeling is Crohn's Disease. An inflammatory process happens in the small bowel or colon that leads to narrowing and stiffness in the intestines. [6:28] Also GERD (reflux) can lead to stricture, over time. It is just much more rare to see a GERD-induced stricture as opposed to EoE.   [7:13] We are not sure, but to some extent, we think of remodeling as not being reversible. Once there is a certain degree of stiffness, the esophagus does not seem to open up without these dilations. If you can control the inflammation, you can halt the stiffening. Maybe there is some degree of reversibility.   [7:44] In the Phase 2 dupilumab trials, investigators found that patients on dupilumab were seen to gain two millimeters in diameter of the esophagus, compared to the patients on placebo. We may be able to prevent some remodeling if we catch it soon enough. More research is needed.   [8:33] Dr. Muir tells of the work she is doing in her lab. They take biopsies from patients and grow collagen-secreting fibroblasts in a dish. The research is to find out what calms the fibroblasts down from actively secreting collagen.   [9:22] It's tough to follow the symptoms of EoE when patients only have difficulty swallowing foods that are hard to swallow. If patients are not challenging their esophagus, they might not notice having daily trouble swallowing. It's hard to ask a young kid who is eating a lot of soft foods if they feel like anything's getting stuck.   [10:06] Dr. Muir will ask teenage patients, “Do you ever want to eat chicken? Do you ever want to eat steak?” A lot of times they don't want to eat it, perhaps because it felt uncomfortable at some point in their life and they don't want to eat it, not based on taste but on repeated bad events. It's hard to tease out the symptoms, sometimes.   [10:27] Dr. Muir says, based on our Functional Luminal Imaging Probe (FLIP) studies, patients who had feelings of food that felt stuck in the last 30 days did seem to have a more narrow caliber esophagus. There is not a 100% correlation between symptoms and remodeling, but there seems to be some correlation.   [11:31] Ryan tells how patients have tendencies to get around their EoE symptoms, with a personal example of keeping food in his mouth and chewing it for a long time before swallowing. A scope would show he had bad inflammation of the esophagus. He had been diagnosed when young and was under treatment and on a restricted diet.   [12:26] Biopsies don't always get a sample below the surface to check for fibrotic cells so it is hard to find remodeling with biopsies. There are some visual signs. Seeing rings or trachealization in the esophagus, or narrowing, can be signs that there is some remodeling under the surface.   [13:38] For kids who have a lot of trouble swallowing, Dr. Muir performs an EndoFLIP test regularly. The test catches subtle narrowing that may not be visible to the endoscopist. Doing this test gives the doctor more information and a better sense of the patient's phenotype, such as inflammation, the esophagus being stretchy, or being stiff.   [14:49] The EndoFLIP is a balloon with an imaging probe that includes a TV for the doctor to see how many millimeters the esophagus is in diameter as the balloon inflates along the whole body of the esophagus. It's not an imaging test that goes to radiology. It's a balloon that is blown up slowly with salt water and that gives this measurement.   [15:18] The EndoFLIP is a helpful tool to help determine who may have some more stiffening or determine exactly what the diameter of the esophagus is before starting treatment.   [15:33] One of the things that Dr. Menard-Katcher of Colorado, Dr. Ackerman of the University of Illinois, and Dr. Muir collaborated on was to look and see if they could find any markers in the esophagus that would relate to some of the things that are obtainable on biopsy or the esophageal string test.   [15:57] What they found was that periostin — a protein made by the epithelium and by the fibroblasts, which is known to activate fibroblasts, and is very high in EoE — seemed to correlate with the EndoFLIP measurements. This makes Dr. Muir think that there might be some potential for biomarkers to detect remodeling.   [16:16] The thing that everyone wants for this disease is to find a biomarker where we don't have to do a scope. As far as finding a non-invasive biomarker, we're not there, yet. There are some things going on at the tissue level that might clue us in on how distensible the esophagus is.   [17:18] The thing Dr. Muir worries about the most with long-term inflammation is that the esophagus is going to get more narrow over time. That will make patients more susceptible to food impaction (although not all patients with food impaction have a stricture).   [17:36] One worry is that the esophagus will get so narrow that an endoscope will not be able to pass a stricture. That will lead to more swallowing problems. That is what Dr. Muir hopes to be able to prevent as we get better at treating this.   [18:09] Any of the treatments that stop the inflammation and help get you below that “magical” 15 eosinophil count that we all strive for, will help prevent remodeling. So, once you get everything calm, hopefully, the remodeling process will stop. However, with the stiffening, the fibroblasts get more excited and have a hard time turning off.   [18:53] Simply turning off the inflammation will not turn off the fibroblasts. Many people within the GI space are looking at fibroblast-directed therapy, especially in Crohn's disease, there's a real need to prevent a lot of surgeries that are happening. Dr. Muir hopes to apply some of these to the esophagus, as well.   [19:16] In the study by Dr. Menard-Katcher, Dr. Ackerman, and Dr. Muir, there were 80 patients. Some were on swallowed steroid treatment and others were on an elimination diet. There were not enough patients on each therapy to find a significant difference in remodeling between the therapies. Patients in remission had better distensibility.   [19:44] Dr. Evan Dellon showed in a paper that patients who have sustained remission have fewer dilations, in the long term. While we don't have a way to reverse the fibrosis that's happened, we hope to prevent it from getting any worse. Dr. Muir's research goal is to find something to calm fibroblasts down and prevent fibrosis or even reverse it.   [20:31] Dr. Muir explains that cells under the surface level are fibroblasts. When eosinophils and T cells come in and secrete antagonizing chemicals, the fibroblasts turn on and start secreting collagen. The fibroblasts also turn on when the epithelium is angry and inflamed. There is also evidence that surface cells can secrete collagen.   [22:46] Dr. Muir says it's hard to know how far along in development some anti-fibrotic drugs are. We have many promising targets. Understanding how the remodeling happens is very important to be able eventually to treat this disease. Even though it seems like incremental progress, Dr. Muir believes research is moving the field forward.   [24:16] Dr. Muir says her EoE patients at CHOP are generous with their blood and tissue. Getting consenting control patients for lab studies involves a lot of leaps of faith and trust that scientists will grow your cells ethically. Dr. Muir feels lucky she has a good research team that explains things in lay terms to control patients.   [26:50] Dr. Muir's team has videotaped pediatric EoE patients and control patients' eating. The time EoE patients spent chewing and how long it took to swallow correlated to their esophageal distensibility measured by the EndoFLIP test. She believes that how we feed and the difficulty we have swallowing have to do with esophageal remodeling.   [27:41] That's Dr. Muir's next area of study. It's being spearheaded by Dr. Kanak Kennedy, a fellow in Dr. Muir's lab, trying to figure out the relationship between pediatric feeding and remodeling.   [28:08] As part of their research, they are videotaping as many kids eating as they can. This involves many control patients who don't have EoE. Another area of research is on the enzyme lysyl oxidase which organizes collagen into bundles and makes it stiff. She is looking into ways to decrease the organization of the collagen.   [29:08] Ryan thanks Dr. Amanda Muir for coming on the podcast and giving a crash course on remodeling and EoE.   [29:14] To learn more about eosinophilic esophagitis, visit apfed.org/eoe. To learn more about Dr. Muir's research, read her paper.   [29:30] To find a specialist, visit apfed.org/specialists. To connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at apfed.org/connections.   [29:47] Ryan and Holly thank Dr. Amanda Muir again for joining them. Holly thanks APFED's education partners, linked below, for supporting this episode.   Mentioned in This Episode: Amanda Muir, MD. Children's Hospital of Philadelphia (CHOP) American Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of AstraZeneca, Bristol Myers Squibb, Sanofi, and Regeneron.   Tweetables:   “I was able to start my own EoE clinic at CHOP as part of their Center for Pediatric Eosinophilic Disorders. I see patients who have eosinophilic gastrointestinal diseases and then I can go back to the lab and bring those questions from my clinic to the lab.” — Dr. Amanda Muir   “The thing that everyone wants for this disease is to find a biomarker where we don't have to do a scope.” — Dr. Amanda Muir   “Any of the treatments that stop the inflammation and help get you below that ‘magical' 15 eosinophil count that we all strive for will help prevent remodeling. So, once you get everything calm, hopefully, the remodeling process will stop.” — Dr. Amanda Muir   About Dr. Amanda Muir: Amanda B. Muir, MD, Attending Physician, Children's Hospital of Philadelphia, Research Institute. Dr. Muir investigates the mechanisms underlying esophageal fibrosis to improve therapeutic and diagnostic approaches.

Your family is...loving? Your family is...hurtful? Your family is...all this and more? If you feel overwhelmed when you think about your family, this episode will help you understand your anxiety and give you evidence-based tools to repair it.  Dr. Mariel Buqué is a leading specialist in trauma psychology. She says our physical and mental health challenges can be rooted in family trauma passed down through the generations—not just culturally, but even biologically.  We're talking about her new book, Break the Cycle: A Guide to Healing Intergenerational Trauma.   Transcript   MARIEL BUQUÉ: My family is loving and hurtful. My family is nurturing and invalidating. They have a mixture of characteristics—and I myself have also been a part of how this family has operated, perhaps in dysfunction, for a multitude of years. BLAIR HODGES: How do you feel about the family—or families—that you were raised in? Dr. Mariel Buqué says a lot of our current physical and mental health can be better understood based on how we answer this question. Dr. Buqué is a leading specialist in trauma psychology. She says a lot of families go through cycles of dysfunction, and these cycles are passed on, generation to generation—not just culturally, but even biologically. She says understanding our trauma can help explain why some of us are people pleasers. Or why some of us find ourselves in codependent relationships. Or why we avoid relationships. Why some of us avoid forging our own families, or why we forge unhealthy wounds. Dr. Buqué has been helping to develop cutting edge therapy techniques to address trauma to help heal minds, bodies, and hearts. Today we're talking about her new book, Break the Cycle: A Guide to Healing Intergenerational Trauma. As you listen to various episodes of Family Proclamations, I think chances are you're going to hear things that touch a raw nerve. I've definitely experienced that myself as a host. I hope this episode provides some ideas about how to address those feelings, and maybe become a cycle breaker yourself. There's no one right way to be a family, and every kind of family has something we can learn from. I'm Blair Hodges and this is Family Proclamations.   A KEEPER OF THINGS (1:52)   BLAIR HODGES: Mariel Buqué, it's great to have you on Family Proclamations. MARIEL BUQUÉ: Thank you so much for having me. I'm excited to be here. BLAIR HODGES: Yes! We're talking about the book Break the Cycle: A Guide to Healing Intergenerational Trauma. And this is one of the newest books that we're going to be covering, this one actually comes out in January of 2024. So first, I just want to say congratulations on the new book! MARIEL BUQUÉ: Thank you, I'm excited for it to be out in the world and for people to be getting their hands on it, and hopefully doing a lot of good healing from it. BLAIR HODGES: It must be an interesting time, because you've spent so much time with this book already. And now it's coming out. So by the time it gets in people's hands, you're sort of like, “okay, like, I've spent so much time with it,” how does it feel? MARIEL BUQUÉ: I keep telling people that it feels almost like that moment when a person who is about nine months pregnant is ready to just birth their child and meet them and have them out in the world. But also, because I just don't want to hold it anymore. I want everyone else to have it. BLAIR HODGES: I do too. Let's start by talking about how you personally used to be a keeper of things. And maybe you still are resisting this impulse. You describe hanging on to stuff even when you don't need it anymore, and that you even experience some guilt or fear when you think about throwing something away rather than finding some use for it. Talk about being a keeper. What are some of the strange things you've kept in the past where you've been like, “Ooh, should probably get rid of that, but I can't!” MARIEL BUQUÉ: Oh, my goodness, I haven't gotten this question. And it's such a good one, I appreciate it very much. So, you know, the actual through line especially in my maternal line, my grandmother, my mother, we've had this way of actually keeping things, first to preserve them for anybody else that might need them even if they're not functional items. And secondly, because of this terrible, terrible guilt of being wasteful. And it comes from there being a lot of scarcity in their lives, my life growing up, and feeling like if we don't keep every little thing no matter what it is that there's a likely chance that we might just be left with nothing. So it was just this irrational fear that was so profoundly ingrained in me. And you know, as far as keeping you know—there's so many things but one thing that I find to be particularly interesting that I've been able to keep and use to the last little bit for years and years and years is actually a white sage that I have. I've had it for about—I've been burning almost the same three bunches for like five years. BLAIR HODGES: Oh wow. MARIEL BUQUÉ: Which in part, I say it's a good thing because there's a lot around that plant that, you know, we're kind of over-utilizing it in on the planet. But I felt like that was like a such a curious thing that I continued to do, even though I'm still working on not being so much of a keeper, that I am so carefully preserving every last bit of everything. Even to this day, I have little things that I do still. BLAIR HODGES: You talk about how it comes from sort of a scarcity mindset; you mentioned poverty or need in your family's history and how that kind of gets passed down. That's why I wanted to start off with this personal example of yours, because your book talks about how some of the things we experienced in our lives are directly connected to what we've inherited. What came before us. Our ancestors, our direct relatives. I want to ask about—was it a mug that you broke? MARIEL BUQUÉ: Yeah. BLAIR HODGES: My heart went out to you, because I used to have this small little drinking glass that was my mother-in-law's, and I made fun of her for it. I said, “Who would ever need a glass of that size?” And she said, “It's perfect for juice at bedtime.” And she since passed away and I started using that glass and fell in love with it. And I would drink a little juice before bedtime. And one day I dropped it and broke it. And it was terrible. Because she's gone. And now my glass is gone. MARIEL BUQUÉ: I share the sentiment! Like, it still kind of makes me a little bit tender to even reflect on the fact that I broke that mug. Now, my grandmother, she lived in this—one might call it almost like a hut. It wasn't even a proper home. It had no indoor plumbing, you know, it was just this set of sticks really in the Dominican Republic. And for her to actually find a way to make this mug reach my home in the US was just like, I could tell the profound sense of love she had for me, that she did so much to try and provide me with a gift. And yeah, I felt an immense amount of guilt. I felt also like I could never see the cup again, like it just it was gone, right? And so there's this yearning for that part of my journey and my connection to her, to have been there. So actually, you know, I'm in the process right now of actually—I'm in a ceramics class, I'm actually going to create my own cup that in essence emulates the one that she gave me. BLAIR HODGES: I like that. MARIEL BUQUÉ: Yeah, it's a way that I can visibly still stay connected to that cup. But it did make me feel a deep sense of guilt. And guilt is that general kind of, let's say, more common emotion that we tend to experience in my family. We're very guilt driven. We're very guilt motivated. We're a guilt people. And we understand that about each other, too. So sometimes, you know, we utilize guilt almost to kind of get each other to do certain things. [laughs] Some subconscious, some not subconscious. But guilt has been so prominent, and it left me with this deep sense of guilt that was really hard to shake off for a number of years.   DEFINING INTERGENERATIONAL TRAUMA (7:22)   BLAIR HODGES: Okay, so we've talked about this physical object that you inherited, this beautiful mug that's now gone, and also a sort of temperament or an inclination toward guilt that you inherited. We're talking about inheritance here. Your book talks a lot about trauma as an inheritance—intergenerational trauma. Let's hear a definition of that. When you're talking about intergenerational trauma, what do you mean? MARIEL BUQUÉ: What I mean by it is, intergenerational trauma is the only type of trauma that is actually handed down our family line. It actually is at the intersection of our biology and our psychology. If we come from individuals who have actually endured adversity—chronic adversity, specifically—that has led to trauma symptoms, and that they didn't get a chance to actually resolve those symptoms and lived with the experience of trauma for a long-standing period of time, that it would have actually made its way into altering their genetic encoding, or their genetic markers or genetic expressions, as they call them in a scientific way. And that, upon conceiving us, both parents would have transferred over that genetic makeup that would have also included some emotional vulnerabilities or predispositions to stress and trauma. And then in comes everything else that life throws at us once we're born, which is our psychology. And if we're born into that family that perhaps is still under some sort of distress or trauma, and we're not feeling like our home environment, the initial home environment we grow into, is safe, or feels nourishing, or helps us to develop enough of an emotional foundation of connection and a sense of trust—which are basic elements of our foundational makeup—then we're gonna start developing symptoms of unrest. And then everything else happens in life. We can go into the school system and get bullied, we can get into a really bad relationship and all of a sudden, there's toxicity and cycles of abuse that are part of our journey. We can actually suffer from having a marginalized identity. And so all of these things play into our psychology. And when they're matched with an already vulnerable emotional state that is there since birth, and even before of birth, then we have the recipe for what we call intergenerational trauma. BLAIR HODGES: And it might sound unbelievable to some people, to think that something that could happen to an ancestor of mine, a stressor or some traumatic event, could literally be passed down. So later on, I want to unpack that biological inheritance and how that works, what the science says about it, so people can really wrap their heads around it. But before we do, let's talk about trauma in general. Your book introduces us to the fact that there are big “T” traumas, the big ones, and the little “t” traumas. Give us some examples of these and how they're different from each other. MARIEL BUQUÉ: Yes. We bucket trauma into those two categories, big T, little T, capital T, lowercase t, there's different ways of referencing to it. But the big T traumas tend to be the kinds of traumas that actually threaten our sense of safety. They make it so we believe we may not survive the moment. Those kinds of traumas can be like theft at gunpoint, maybe getting into a car accident. It could also be the types of traumas that really hit hard and are very profound, like childhood abuse and neglect. Things like that tend to be like the bigger T traumas. Now, the small t traumas tend to be experiences that unnerve us and unravel us, but don't necessarily threaten our sense of safety. A traumatic experience that would be categorized under small t could be perhaps losing a job and then entering into financial difficulties. It's not that your life is being threatened or that there is a critical moment in your infancy where there's a profound disruption. But there is enough of a disruption in your life so as to say you're living under some element of trauma. Now, the thing about big T and small t trauma is that there are times when people suffer a big T trauma, and they experience enough nourishment, enough support and love in their lives—whether it's from a caregiver or other family members, community members, people that just hug you and care for you through those moments, and those symptoms can actually dissolve. And we can have somebody that has an accumulated, layered number of different small t traumas happening throughout their life that go on and addressed, and the layering of those can actually accumulate into really intense trauma symptoms. So on both ends, it's really about not just what happened, but also, how were you taken care of through it? And then also, were there other things that were also tossed into the trauma bucket that could have made life a little bit more difficult to bear.   YOUR ALLOSTATIC LOAD (12:23)   BLAIR HODGES: The big term you use for this is “allostatic load,” it's sort of like all the stuff that adds up over time. I've also heard of “weathering,” a weathering thing. And I've heard this in racial studies where they talked about all the microaggressions that people of color might experience just add up over time to increase the likelihood of heart disease or chronic stress. So what you're talking about are traumas that affect our emotional state, but they also affect our body. Talk about how trauma has not just psychological and behavioral consequences, but also some physical consequences in the way our bodies try to deal with stress. MARIEL BUQUÉ: The allostatic load that you reference is actually the wear and tear meter of the body. And you know, neurologically, where we are actually formatted as humans to go through stress and then resolve that stress and then come out of it. Our nervous system is actually structured to be able to go into a state of alert if it senses there's some elements of danger in our environment. And once the danger has passed, then our nervous system says, okay, we can rest, digest, and calm, and we feel at ease, we go into balance, we call it homeostasis. However, if we're not able to acquire that sense of balance on an ongoing basis—meaning that, for example, as you mentioned, individuals that experience racial discrimination on an ongoing basis, there is a little chance to actually recover from the last emotional injury or the last racial injury. And so then they go into yet another battle, and yet another situation, and yet another, and their nervous system—which is connected to all of their organ systems, which is connected to their brain, you know, it's all a part of one uniform system starts wearing down. And what happens is that the organs that are connected also start wearing down. One example that I think is fairly common to offer is that of gastrointestinal discomfort. So our nervous system has endings that land right at our gastro tract. And so whenever we're in a state of alert and we sense that there's danger, our nervous system is actually partially shutting down non-essential functions, which includes the function of actually digesting food. So our actual gastro tract is constricted, in part. And so when we think about, for example, individuals that complain of symptoms that mirror irritable bowel syndrome, and we start looking into their history, and we started looking into the things they battle on a day-to-day basis, there are some correlates. We start seeing the fact that these individuals are suffering stressors and traumas on an ongoing basis. And sometimes, when we start addressing the trauma factors themselves, the so-called IBS symptoms tend to dissolve. Which means that one, we're actually diagnosing physical conditions that are tied to stress, right, we're not actually addressing the stress, which is the root. And in addition to that, it's all one body. So it's interconnected. And that happens with many other things like a lot of cardiac issues have been mapped back to stress and trauma. A lot of autoimmune conditions have been connected to trauma in very specific ways. And even some cancers have had trauma elements, they're stress-derived as well. And so when the body is worn down, the body breaks down its own capacity to actually fight off any physical threat, meaning any cancers or any other conditions like viruses, or anything that may inhabit the body and then leave room for chronic illness to take root. BLAIR HODGES: During COVID, the irony there is, the stress could make someone more susceptible, and we have to consider the ways that the pandemic itself was a trauma that could make people more likely to have their immune systems compromised because of the stress that the pandemic itself caused. When I think about it in terms of family systems—you talk about family abuses that happen, it could be emotional abuse, physical abuse, sexual abuse. And those can actually affect the physical health of the people that are encountering them, and not just in getting hit and being hurt from that. But as you said, in the way your digestion works, in your heart health, and your nervous system in general is really getting rocked. People that grew up in these unsteady or difficult home situations are going to pay the price throughout their life. It's not necessarily the case, right, that someone can just get out of that situation and then go on with their life as an adult. What you found in your practice is a lot of people who are carrying ghosts of their family life with them, they're still haunted by those ghosts MARIEL BUQUÉ: Very, very long into their adult lives. And it's something that tends to hurt at a very profound level, but tends to impact so many aspects of a person's life. People's relationships get impacted by their childhood experiences that are adverse. Their work gets impacted. Many times, we tend to see that people struggle with attentional difficulties that are really not a biological difficulty, like ADHD proper, but that the person is in essence, dissociating with higher frequency and as a result, not able to attend even to their job duties in the ways that they would have they not been in a state of trauma. The way that people parent is very much impacted by the trauma factors in their lives. It is even said that—although we cannot say that parents who are individuals that have suffered childhood abuse in the past are going to, in essence, abuse their children. But the studies do show that there is a higher risk of those very same parents perpetuating the very same traumas they suffered. So as far as data is concerned, we do have data to support that. We have to really make people conscious and aware of how their past is impacting their present person, so they don't replicate those trauma cycles forward.   BACK IN MY DAY (18:39)   BLAIR HODGES: Alright, I want to talk about traumas and triggers. You talk about how different things can trigger a trauma. So you might have an interaction with a boss at work that triggers something in how you're related to a parent or a caregiver or a teacher from your youth, that triggers things. And your book describes the resulting trauma responses. Things like having a short fuse when you're stressed out, behaving in self-destructive ways, maybe a propensity to become addicted to substances, being chronically pessimistic, being jumpy, self-blame, self-loathing, a lack of being able to generate emotional intimacy. These trauma responses are going to be familiar to a lot of listeners. And what I've heard, especially recently, is people complaining and saying, “Oh, all this talk about triggers and trauma is too much. People are just too fragile these days. We just need a tougher mindset. When I was growing up, we didn't have traumas and triggers, we didn't have to worry about it,” and so on and so forth. “You're all snowflakes,” whatever. And I'd just like to hear your response to that kind of criticism of, “Oh, even talking about this is just too weak, it shows fragility.” MARIEL BUQUÉ: [laughs] Well, I have a lot of things I'd like to say that can help us to really understand that perspective, believe it or not. Because the thing about people—I'm gonna place the people that are saying things like that in older generations, right? Maybe like, we'll say boomers, right? BLAIR HODGES: Yeah. [laughs] Glad you said it. I didn't have to. For all my Boomer listeners out there. It's all Mariel. Not me!  MARIEL BUQUÉ: [laughs] You know, just placing an example, for sure. But there is this idea that, well, you know, “I went through the same thing, I turned out just fine, you should be fine.” And we have to also reroute to what the science is telling us. Science is telling us that, with each generation, we have an accumulation of an emotional burden that deposits itself into our minds and into our bodies. And that when it goes on unresolved, it just passes on, but it gets compounded. So when we're talking about people in other generations—and let's even say down to Gen Z, and even the generation that's coming after them, because I think a lot of the sensitivity talk is mostly geared towards them, we have to think about the fact that we—even the millennials and Gen X that have been parenting these children—a lot of us have been suffering, and have had a lot of traumas that we haven't resolved because they stemmed back generations. And also because we just didn't know, a lot of us didn't know and still don't know, that these traumas exist within us. And as a result, the biggest risk with unresolved trauma is the risk of transmission. So when we're looking at these kids who are highly, highly anxious, some of them very, very depressed, they have their own global mental health crisis that's burgeoning at the youth level, and their suicide rates are ridiculously high, it's safe to say that the sensitivity they're experiencing isn't just coming from the fact that they all suffered a global pandemic. I mean, being a child in a pandemic, I can't imagine. But in addition to that, the fact that they actually have an accumulation of genetic material, of biological data that's in their own bodies that also produces that sensitivity. I like to take it there, because we can rationalize back and forth with different generations about different perspectives. But when we start looking at the truth of how our bodies hold trauma, I think that gives us all an opportunity to hold greater compassion for one another, for the ways in which we're holding emotional pain. BLAIR HODGES: This is the real value of your book, is that it's not focused on just the individual. I think a lot of pop therapy today can be really focused on the individual. Self-improvement, self-authenticity, finding your best self, being your best self. And it can even seem narcissistic at certain points, depending on the pop therapy that we're talking about. But your book shows us that dealing with trauma and striving for self-improvement don't have to happen alone. And in fact, it's better to not think of them in isolation, because trauma is interpersonal and intergenerational. MARIEL BUQUÉ: Yes.   THE BIOLOGICAL TRANSMISSION OF TRAUMA (22:57)   BLAIR HODGES: So as you said, it can be transmitted both biologically and socially. Let's now get more specific about that biological transmission. This is the part that I just didn't have a lot of knowledge on. And to learn about the actual science behind how trauma can get passed on really opened my eyes. Give us a sense of how that works. MARIEL BUQUÉ: I'm gonna take us back, actually, to the moment in which our grandmothers were actually pregnant, and they were five months pregnant with a baby in their uterine wall that was a fetus that was developing. In that moment, as it were five months pregnant, the fetus, regardless of the sex, had actually developed precursor sex cells inside of the reproductive organs that would have eventually developed into being you. So at a specific moment in our lives at the very onset of our lives, when we developed into just one tiny, microscopic cell, we were living inside of our grandmother's womb, because we were three generations existing in one body—our grandmother, the fetus that was our parent, and then us inside of their reproductive organs. And when we start looking at when we actually developed—because we believe that we developed in our parent's womb, and we forget that there is a lot more biological data and even social data that we've been capturing from the environments around us well, before we were born, two generations prior, even, when our grandmothers were experiencing any kind of stressors, those stresses were actually filtering actual hormones like cortisol and other stress hormones into their bloodstream. And that was reaching the fetus inside of them, which was our parents, and eventually it would have landed onto us. And so everybody in that one body, that intergenerational body, was experiencing that stressor, whatever it was, they were experiencing it. So when we start thinking about biologically, what is happening, what is transmitted, how are these things interconnected, it starts making a lot of sense. And there's a lot more in the biology. I mean, I didn't get that technical in the book, because I thought it might overwhelm the reader. But there's also a lot of biological understanding from different points of expertise, different fields of study, that we understand that there's also some genetic material that's left behind in the grandmother when she gives birth. And then in the mother when she gives birth. So there's still genetic material that's tying each of these generations. So much is also implicated there in reference to what is happening intergenerationally, where there's this biological bond. Now fast forward, to now. Let's say you're already born. And now you have a parent who maybe their way of coping through stress is to yell at you. They yell all kinds of things, right, in order to just release that stress tension. What happens to that—let's say you're three years old—to that three-year-old little nervous system that has to digest this yelling big human. That little nervous system starts internalizing that the world is not safe, and it starts defaulting into a threat response, into an overactive nervous system response. Now, let's not forget, of course, that we're already talking about biological vulnerabilities and predispositions that are already manufactured inside of you. All they need is a trigger point, they need something to turn on that trauma response. And if you're living in a home where, we'll go back to abuse, perhaps you're being physically abused and psychologically abused, you're not feeling a sense of safety in the very place where safety is supposed to be formed and nourished. And so all of that is being factored into your nervous system as well. So when we're talking about the biological elements, we're talking about some of those epigenetic markers that we talked about at the beginning. We're talking about also the ways in which we exist in these three bodies in that genetic material, but also biological material is being transferred into these three bodies. And then beyond that, we're also talking about our nervous system and the ways in which it's being formed and structured around a sense of lack of safety. BLAIR HODGES: That's a helpful introduction. And as you said, you don't get too far into the weeds in the book, which I think is helpful. This is a book for a general audience. But you do let people know that there are research studies going on in cellular biology, psychiatry, psychology, neurology, neuropsychology, embryology, interpersonal neurobiology, psychoneuroimmunology—some of these I've never heard of before—developmental sciences, epigenetics. There are a whole bunch of different fields focusing in on this biological transmission. I think people probably picked up on the fact that it's not isolated—to talk about nature versus nurture is to perhaps introduce kind of a false dichotomy. Like genes exist, DNA exists, inheritance exists, but they're also triggered by social things. And so the nurture and the nature—it's really tough to separate those things. You also talk about how families develop their own intergenerational nervous system. When I thought about nervous systems, I just thought about my own nervous system, it's a part of my body. And you're talking about a nervous system that shared among people. And as soon as you described it, I could recognize this, this is where a family has to become so attuned to each other, for good or ill. So maybe you have a parent who's out of control, or really has anger management issues. The whole family has to have their nervous system attuned together to pick up on signals and to be prepared for things like that. Maybe spend a second talking about how that intergenerational nervous system gets built, and if you have an interesting example from a client or something like that, to give people a sense of what that looks like. MARIEL BUQUÉ: Absolutely. I think an example is a great place to land because that is a way that we can actually visualize something that can be so complex. For example, let's say that we have a child who is ten years old, they just got home from school, and their mother had a really, really hard day at work. So this child now asks where their food is, right, and maybe they use a certain tone and the mother just completely lashes out. Let's say that the mother's default nervous system response is to yell. She is constantly in fight mode. That's what we call it right? That's her default. And so she lashed out and displaced onto her child who was asking for food. What he did was actually run to his room crying, because his default nervous system response is to flee. Now, we have a grandfather who also lives in the home. And he comes out of his room, and he says, “Please stop yelling at this kid, please just stop. Is there anything that I can do, just stop!” That's a fawn response. It's a way in which a person would do anything to make the pain go away. And so right here, we have this contagion effect of everyone being in a state of distress because of what happened to one individual and the ways in which they responded and displaced. However, they are all having different kinds of ways of expressing that distress and that trauma response. They have different nervous system threat alarm states happening all at once, but they're feeding off of each other. And that's what I mean by the “intergenerational nervous system.” That being the psychological elements. The biological is a lot of what we've already covered. There are ways in which we're interconnected and biologically hardwired with the people that we come from. However, once we are in separate bodies, there's ways that we continue to feed off of each other's nervous system responses. And we create this contagion effect within our homes of emotions that continue to run rampant. And that tends to happen a lot with families that have emotions that have not been taken care of, or that have a lot of chaos within the family themselves.   THE INTERGENERATIONAL TRAUMA TREE (31:38)   BLAIR HODGES: That's Dr. Mariel Buqué. She's an Afro-Dominican psychologist who received her doctorate in counseling psychology from Columbia University, where she also trained as a fellow in holistic mental health. She's a world-renowned intergenerational trauma expert. We're talking about her new book, Break the Cycle: A Guide to Healing Intergenerational Trauma. Mariel, as we've mentioned, and this can get pretty complicated, but you break it down simply with the idea of a tree. And this should be a pretty easy thing for people to latch on to, we already think of our family tree. But maybe break down, how you identify the pieces of the intergenerational trauma tree—the leaves, the branches, the trunk, the roots, and the soil. MARIEL BUQUÉ: You know, what I found within my work and a lot of the therapies I've been trained in is that we have these beautiful, beautiful tools that are really helpful, including trauma trees. But they weren't necessarily filling in the full picture of what I was seeing in the therapy room when it came to intergenerational trauma, which is why I decided to move forward with developing a new version of a tree, the intergenerational trauma tree, that actually had all of these different elements you just noted within them. And they're very specific for a reason, because they're part of what we then utilize in order to help the person create a trajectory of healing and then integrate that into their healing process. The leaves of the tree signify one family member, each leaf. And each of the leaves actually reflect not only what may have happened to that individual that could have been appraised as traumatic, but also any actual trauma symptoms, or trauma responses that burgeoned in that person as a result. And this also includes the possibility that some trauma symptoms may have been reflective of physical conditions or physical discomforts, like chronic migraines, for example. And so we start making sure that we map out every individual that a person desires to be a part of their story, or for whom we have some sort of a record of, you know, of their lived experience. And we start mapping out the leaves of the tree. And this also includes any of our descendants, whether they are our children, grandchildren, anybody who is related to us. And for some people, it is chosen family, and people who we've just had some level of proximity to them. And even some sort of connection or child rearing. The trunk of the tree signifies us. So it signifies the ways in which we've internalized the hurt. What has happened to us. Ways in which we have been unwell in our mind, meaning that perhaps our thoughts have been frozen in this idea that nobody can be trusted, right, and that's just the way our minds have been able to organize around trauma. And in our bodies—like perhaps we are that person that suffers that gastrointestinal discomfort that mirrors IBS. And in our spirit, and spirit usually is how connected we are to others, to ourselves, into the greater whole. And so if we suffer a series of bad relationships, or if we have a really tough relationship with ourselves, that's something to consider also, and something we have to bring into the trunk of the tree to hold an understanding around it. The interesting part about the trunk of the tree is that I also asked one question, which is, “How have any of the trauma responses reflected in this trauma tree impacted you?” So we can look at our parents and think, okay, well, you know, I had a parent that perhaps drank alcohol every night to numb their emotions, and that was their trauma response. And that impacted me and my sense of well-being, my self-esteem, right, and so we have to bring in that question to have an understanding. How is it that the people who were not able to break the cycle left room or opportunity for you to then experience trauma. The root system of the tree is one in which, for me I believe what needed to be reflected there were all of the internalized beliefs that we've held about ourselves, that stem from what happened to us, that stem from whoever didn't actually disrupt the cycle. A lot of people that suffer trauma say the words, “I am broken.” So I thought that that would be an important piece of what needed to be added to the system so people can really see it and visualize it and see the intergenerational trauma tree that's reflected in the book, and really understand, okay, you know what? That that's actually an internalized belief, it's not an actual truth. And so there are ways in which we start internalizing these ideas about ourselves in the world that then become almost kind of immobile, they become frozen in us. Beyond that, of course, is the soil system, which I think is always not attended to within any other trauma tree systems, but we have to think about the soil because it's such an integral part of the tree's growth process. And in the soil system, we have everything that feeds specific beliefs into our homes, into our families, into our communities. And that's anything that even stems from, like, the idea that you can pick yourself up by your own bootstraps, right? It's a systemic idea that also feeds itself into our homes. Or the idea that we don't air our dirty laundry, or we don't tell family secrets. And that can actually lead individuals who could use help inside of a family unit, lead them to experience shame, and not seek out help, and then just perpetuate harm onto the people around them, which is usually their family members. So the tree needed to be that comprehensive so that we can have a very global and well-rounded way of being able to look at what happened here through the generations. And then how can we take that information to then transition into how you can heal more profoundly, but in a more well-informed way.   YOUR SOIL SYSTEM (37:35)   BLAIR HODGES: For me, your intergenerational trauma tree system helps me kind of escape the temptation to blame and instead, to seek for more understanding. So for example, I might have a relationship with a parent and feel like, “Oh, this parent failed me in this or that way. And I can just put the blame on them, they let me down as a parent,” so I'm not attending to the soil. And I think, in this case, the soil a lot of times would be like cultural gender expectations for what a proper mother would be, or a proper father would be, and how those things hurt that parent, and how that soil affected that parent in the way they parented me. But it's harder, and I think less common, to zoom out like that and think about the cultural impacts that are happening, the soil that's feeding that person. I think it's a lot easier to just say, “That person hurt me. That's the cause,” and sort of hold on to the resentment there, the pain there, without attending to the bigger things. The other thing is, it's hard to imagine myself as really being able to affect the soil in any big way. So I feel like, for me maybe it's been easier to just blame individuals because I feel helpless when it comes to the context, when it comes to the soil, like I can't really do much about that. I'm interested in your thoughts about bringing attention to that soil just a little bit more, because I think this sets your approach apart from a lot of the therapeutic “pop-therapy” stuff I see like on TikTok or Instagram, it really doesn't often get into the soil, it's just more about like, “How to be your best self” or whatever. MARIEL BUQUÉ: You know, if we don't get into the soil, we are just existing in a world that is going to continue to perpetuate trauma and feed it into our homes. And so that's why I found it to be an essential part of what we needed to address. What we needed to address as individuals who have suffered these traumas, but also as a global community, right, because we can't just like place it all on the people who have suffered. But one thing I'd like to say about that, even before I get to the logistics about it, is that I have actually seen individuals who have been socialized for decades—one of those individuals actually is my father, who's 65, and who, a number of months ago had actually talked to me about the socialized gender norms that he was, in essence, taught to believe and taught to behave in reference to. And he almost felt like this “a-ha” moment just kind of came to him about the ways things could have been different, and how he can now enact a different set of behaviors as a result. And I even had a client, my oldest client was 84 years old. And I say these things, because I think that even when we are decades, and almost a lifetime, in these kinds of patterns that have been socialized and have been almost kind of invisiblized in our world, it is possible for us to actually still find a way to look at them. Or if someone else helps us look at them, because they have a different lens, and that we can still create even micro-changes around these things. So in terms of going out into the world and actually doing the work to try and eradicate the parts of the systems we are a part of that actually perpetuate trauma is an essential part of what we need to do. One example of this is when it comes to particularly childhood trauma, and the adverse childhood experiences that people tend to experience, we understand that we can put in place specific educational programs for parents, specific educational programming for children in their health classes, and in other places where children can access information, that can actually help them to understand not only how to cope differently, but also what actually constitutes as maybe even trauma if it's age appropriate. And I think these are places where—I know there are a number of different organizations that have a connection to the original “ACEs” study who are trying to do some of this work, and trying to educate the parent-child dyad, around how to have a connection that isn't rooted in trauma, but rooted in a healthier bond. And, you know, we have to do that work too in order to cut trauma at the root, right? We also have to offer the education, we also have to put in place policies, and bills, and institutional practices, and actually protect people from being further victimized, so that we don't have this more systemic victimization but that all we're doing is helping people solve the emotional hurt in their heart without solving the root cause, which is the institutional dimension of it. BLAIR HODGES: Right, it's sort of like your basement floods and you're putting fans down there to help all the water evaporate and clean it out, but then you're not addressing the fact that your foundation's cracked, and water is just going to come right back in. MARIEL BUQUÉ: Yes.   ADVERSE CHILDHOOD EXPERIENCES – 42:50   BLAIR HODGES: You mentioned the “ACEs” study. This is the Adverse Childhood Experiences Study. And maybe we'll just spend another minute here on adverse childhood experiences and the idea of the inner child, that we all carry this inner child, we have an inner child, and you've developed a tool that people can assess what kinds of trauma they experienced as children, because sometimes we don't even remember the kind of things we experienced, but you want people to kind of tap into that. So we've talked about addressing the soil and being socially involved, and looking at that. Now we're looking at more like what we're doing personally and looking inward to ourselves. Adverse childhood experiences are something you recommend we assess and sort of try to think through what those adverse childhood experiences might have been for us. You've already mentioned one for my kids: COVID and the pandemic obviously was one of those. [And continues to be.] MARIEL BUQUÉ: Yes. Adverse childhood experiences are, in essence, what the words say. It's having experiences in our childhood that create enough of an adverse scenario or environment that it leaves us with emotional remnants that typically carry on into our adult lives. And the layer I wanted to add for the Intergenerational Adverse Childhood Experiences questionnaire that I added in the book are the layers of, not only what happened before us—because like I said before, we understand that there is a higher risk in families that have trauma for trauma to be passed on and to be perpetuated by parents and other people. But that we also needed to know the added element of what happened around you, like a pandemic, like perhaps a hurricane that devastated your community, right? Like all of these things that are very much a part of our lived experience, especially right now in history. Especially for the children right now. I believe it was the World Health Organization that did a questionnaire with some children, and I believe it was fairly open-ended, just to gauge what is making children feel so hopeless these days, because hopelessness is a large part of what leads a person to actually not want to be alive anymore. And we're seeing a lot of that in children these days. And so many of the children actually answered with the fact that they felt like, in essence, their world was imploding. Because we have so many climate crises happening on a day-to-day basis. And it feels like the world they're being raised into is a world that isn't even probably going to be here. That's a real reality for a lot of them that they're confronted with. And we're not really kind of gauging that as the adults in the room, right? We're not realizing like, they're in a world where they don't believe they may make it to 30 or 40 years old and be healthy in this earth, right? And so all of that is part of what we need to assess, to really get a good comprehensive analysis of what really is happening here that is producing adversity. So in comes this questionnaire that helps us answer some questions, but it is also a conversation starter. Because how would I know that, you know—of course, a pandemic, I think it is a little bit more of a given. But quite frankly, I wouldn't have thought about the environmental issues and that children would have already been capturing the fact that those environmental issues could blossom and lead to a destruction of earth and they wouldn't have a healthy planet to exist in. That's a real thing that perhaps some of us are have not been attuned to. So the questionnaire helps us answer a lot of questions. And it also helps us start conversations that need to be had.   PRACTICES FOR YOUR WINDOW OF STRESS TOLERANCE – 46:41   BLAIR HODGES: People can learn more about the questionnaire about adverse childhood experiences in the book, again, it's called Break the Cycle: A Guide to Healing Intergenerational Trauma. We're talking with Dr. Mariel Buqué. This book gives us a lot of information about how traumatic experiences affect us biologically, how our families and family life can impact us throughout our lives. But it doesn't just give us that knowledge. You also wanted to equip people with things they can actually do in their lives to help them heal. And you do have a proviso at the opening of the book that says there's really no replacement for contacting a professional if you can, because that's sometimes necessary when you're working through intergenerational trauma. This book can be helpful to do that, but you also say, “Hey, if things get heavy, reach out to somebody.” I really liked that. But the book has a ton of practical advice, exercises, ideas and things we can do to “broaden our window of stress tolerance.” That's a phrase that you use there. So maybe give us an example of a practice you've personally benefited from in learning to broaden that window of tolerance, being able to handle stress better, being able to heal from some of those past traumas. MARIEL BUQUÉ: Yeah, you know, a lot of the practices I include in my work in the book, and even in my personal life, have a layered element. And what I mean by that is I usually try to incorporate practices that really help the nervous system feel at ease and relaxed, but not just for the sake of feeling more relaxed in the moment. But for the sake of actually restructuring our neural networks, or forming new neural networks, that actually are formatting to a more relaxed body. So it's really essential for us to also think about what we do in response to trauma that can actually help us exist in a more resilient and resourced body moving forward. I usually go to a lot of practices that feel accessible enough to most individuals. I try and gauge people's ability statuses, and most of these tend to be practices most people can do. And these are, of course, deep breathing—I think it's been popularized enough, that we understand that taking breaths is helpful. But I like to pair deep breathing also with other exercises like progressive muscle relaxation, for example, which, for anyone that's not familiar, is a practice in which you tense specific muscle groups, usually with an inhale of a breath—which is how I organize it in my practice—and then you release the breath and release the muscle group. And then you move into the next muscle group. And you complete it usually wherever—typically like your toes, so you go from head to toe. The reason why this is a practice I have incorporated into my practice is because we have so much trauma that's stored as tension inside of the body. And on any given day, we're walking around actually with all of this tension pent up and not being released. And when I usually have conversations with folks about this, they start noticing their bodies. And they're like, “You know what? Actually, yeah!” And everyone's always like, “Oh, my goodness, I just noticed this pain that I didn't even realize was there, this tension in my neck, and there's a bit of a sharp pain there.” And well, that's curious, right, because that was there. But, you know, it took me to gain body awareness and body mindfulness in order to really understand I'm actually carrying some tension there. When we tense the muscles voluntarily, we actually almost kind of release that tension that's pent up there, and the muscles that have been constricted because of whatever threat we perceived, like, three hours ago, that can be released in relaxed. BLAIR HODGES: It could be like clenching your jaw, or just feeling that's where I'll usually feel it, like, are my teeth together? MARIEL BUQUÉ: Yeah, making fists, you can make a balled-up fist, you can squeeze yourself, like you're hugging yourself really hard, right? BLAIR HODGES: Yeah, I liked that one. I liked the song one too, where you find a quiet place that's comfortable for you and you can sing, and not just the sound, but literal vibrations of the singing can help your nervous system as well. It's a physiological response. MARIEL BUQUÉ: Yeah, there's actually, so we have this part of our nervous system that's called the ventral vagal nerve, which is the part of our nervous system that's most implicated in helping us to relax and release especially after being excited by a threat— BLAIR HODGES: And by the way, this is very evolutionary, like this is rooted back when we were running away from like some predators trying to get us or something, and our body—This helped us survive, and now it's helping us get super stressed. [laughs] MARIEL BUQUÉ: Yeah, because it's overestimating threat. It's actually seeing threat everywhere, because threat is no longer like that big tiger that was chasing us; threat is now we turn on the computer, you know, we read that first email, and it has a certain tone, and that's a threat, right? So it's like [laughs] it's a very different life we're leading and as a result, threats are kind of all around us. And then we also have ways to really kind of over-appraise a perceived threat. BLAIR HODGES: Okay, sorry about that sidetrack. But it's just fascinating. MARIEL BUQUÉ: Yeah, no, it's super important. And it actually drives me right back to my point where the ventral vagal nerve is actually a nerve we can voluntarily stimulate in order to increase the relaxation response inside of our bodies. And one of the ways in which we can do that in a very effective way is actually by humming. And if we take whatever favorite song we have, and we instead of singing it, we actually hum it, we even increase even more of that relaxation response, because we're creating even more vibrations inside of our bodies, but more specifically, within our ventral vagal nerve, which needs that stimulation, that vibration, in order to get triggered and work in our favor. BLAIR HODGES: And you point out that some of these practices are ancient. Some of the things you're recommending are things that cultures and peoples have been doing for generations, we now have a scientific add-on, sort of understanding a little bit more, perhaps, of why biologically, these things are impacting us. But I also wanted to ask you about that relationship between ancient traditions, long-standing practices and science today. The reason I asked that is because I want to know how people can discern between quackery versus real practices, right? So, “Do your own research” is a phrase that came up around the pandemic, which really meant like, “Don't get vaccinated” or “Don't believe in science at all.” [laughs] So I want to know how you have approached being educated in a university setting, but also honoring and incorporating ancestral or ancient or indigenous and otherwise practices, and negotiating that difference between sort of science quote, unquote, “Western science,” and tradition, and kind of how you navigate that relationship in ways that won't make people say, “Well, I'm never getting vaccinated, because if I hum to myself, I will, you know, I'm gonna get healed” or whatever. MARIEL BUQUÉ: Yeah, there's always nuance in everything, right? I always like to add that. But the way that I see Western modern science is—in part, I see it as a science that is so widely believed, versus, let's say, ancient healing practices. We can even take yoga as an example, right? An ancient healing practice that we are now integrating into our day-to-day lives by the millions, and are realizing even in actual scientific studies that are focused on the brain, we're realizing that yoga is actually helping us to reorganize our brains and grow our brains in regions that are actually health-promoting, and grow memory centers, and do all these things, right? So in part I see the utility of Western science because people believe in it so much. So if we can utilize it to prove that the practices that have been here for thousands of years are actually effective, and we need to look in the brain, and we need to look at the body and the ways the body is organizing itself differently as a result of this practice, then let's utilize it. Let's let that help us buy into the idea of more holistic wellness, if that's what we need to do. So I see its utility. And then I also wish that we would be more willing to actually see how effective some of these practices can be without the use of medical science or scientific inquiry. Now, one thing I always like to go back to is—I'm sure that, especially I believe that whenever I do it, or I instruct people to do it, it feels like a little bit out there, until I can actually contextualize it, which is the practice of rocking. Like swaying side to side and rocking, which actually stimulates that ventral vagal nerve and helps us to feel relaxed. When I incorporate that or tell people to do that in reference to their mental health, they're like, “What are we doing here?” But when we go back to, you know, when we were a baby or a toddler, and people were rocking us to sleep, we were going to sleep. Why? Because our nervous system was actually feeling more calm, at ease, relaxed, and we were able to segue into such a vulnerable state like sleep. And that is the thing that I'm trying to bring us back to. I'm also trying to bring us back to the data that has been there since we were kids, that we actually had, but we lost it along the way, we forgot that we can actually rock ourselves and soothe ourselves. And we even see this in individuals that are on the Autism spectrum. So there are individuals who fall under the category of neurodivergence who actually utilize rocking, intuitively, to soothe themselves. And I think when we can see that people actually do this naturally, because they need that soothing element, or people do this instinctually, or intuitively, to soothe their children, we should be thinking about the fact that this actually has utility. And we should be thinking about truly incorporating it into our day to day lives. And rocking, if we're in our office chair. And we feel like that last meeting was stressful, why not take like two minutes to just kind of rock and sway and like, you know, you can pretend you're listening to some music if you don't want to look weird to your colleagues, but it's really going to help you, so why not do it? BLAIR HODGES: It just reminds me of so many things in your book, these ideas you offer. And I think my biggest obstacle to doing these types of things and incorporating them in my own life has just been impatience. I'm thinking about the end of the day when I'm trying to get my kids to bed and just like, “Go to sleep, why don't you go to sleep? I've read to you. I'm singing to you. I'm rubbing your back. I'm doing just about everything a parent could do. And I wish you were asleep and you're not. And now I'm getting frustrated. And you're asking about you want to write this letter to your friend at school the next day. And I just don't take that time to just stop and breathe. And yet, you also point out that when we're elevated, it can take five or more minutes to come back from that. And I had this false idea that, “Oh, I just need to take like three deep breaths, and I'm right back in it.” But I think what I've realized in reading this book, is that I was actually doing this really short-term coping that was actually just bottling up what I was coping with and pushing it down and keeping it there. Then it would just eventually build up and up and up. So I was really personally impacted when you're talking about the patience that's needed sometimes, like five minutes at least, to cycle through a stress response when I thought I could do it in a couple of breaths. MARIEL BUQUÉ: Most of us think that, because we've been socialized around deep breathing in that way. I mean, I'm really grateful that deep breaths are even entering the conversation in modern-day society— BLAIR HODGES: Sure, yeah.  MARIEL BUQUÉ: But we're not necessarily doing it to the extent that most of us need. And we have to also remember all of us suffered a pandemic, whether it impacted us greatly or not. We all suffered through a global crisis. So we all have some element of emotional remnants that we're still sorting through. And so when we're talking about all of that, and we're also talking about living in bodies that are decades long—sometimes generations of remnants that are still captured there, we can't say that taking three deep breaths is actually going to help us to release the stress. Like we, you know, [laughs] we have to do a little bit more work than that. But usually—especially with parents or people that are busy because their careers just tie them up, I usually get a little bit of resistance around the timing element, Like, who has five minutes? And I always like to reference the fact that, okay, you have one thousand four hundred and forty minutes in a day. If you take five of those minutes to actually regenerate your nervous system in the direction of health, and you do that for a period of a year, I think you're going to be in a slightly different situation emotionally than where you are now. Because what we know about body memory from even a neurological perspective, is that body memory takes an approximate three to four hundred repetitions of these nervous system regulatory practices to actually start defaulting to them. So we actually have so much power within us, within our inherent nature—in our breath, which is literally something that we all carry, that we can actually integrate into our day, and a year from now, bedtime might not feel as strenuous as it feels right now. [laughter]   FALSE FAMILY AND TRUE FAMILY – 1:00:46   BLAIR HODGES: That's right. All right. That's Dr. Mariel Buqué, and we're talking about the book Break the Cycle: A Guide to Healing Intergenerational Trauma. And speaking of intergenerational trauma, again, the book requires us to think a lot about our history. So for some folks, this book will require a lot of effort, especially if they have a lot of trauma and pain in their family history, because you're asking them to think about those family experiences. And in the process, you introduce this idea of the “false family” and the “true family” that we have in our minds. This was a lightbulb moment for me. The false family could be the story we tell ourselves about who our family is. The false family can also be future oriented—it could be a hope that there's some way to fix whatever's wrong with our family. And that we can return to some nostalgic paradise of a past that maybe never even really existed. And then we're stuck with family dysfunction that's not going to solve itself. And that's hard. And so a false family can be not only the story that's not true that we tell ourselves about our family, but it can also be future oriented as well. Talk about dealing with our ideas of our false family, and then what you talk about as our true family. MARIEL BUQUÉ: Our false family is those ideas we've held on to that truly don't hold any veracity for the most part, because they're ideas we've needed to hold on to in order to preserve our idea and our image of our own families. BLAIR HODGES: Like quick give us like just a couple examples of what that would be. A person might think what about their family? MARIEL BUQUÉ: A person might think that their family is loving, and still is not able to—let's say, like, an aunt can be loving, but does not have the capacity to hurt you. Actually, no. That very human aunt that you have has the capacity to injure you. They can say something about your body that could leave emotional marks, you know, for ages, right? Like, there's something that person can do, that actually puts them, almost kind of takes them off the pedestal, and makes it so that this person is now existing both as the aunt that is deeply loving to you, and the one that can be hurtful and damaging to your self-esteem. And so it's like, you know, stuff like that—when I say that, I think any of us, probably our minds go into a multitude of ways in which different family members can and have been hurtful. And it is because we all have families like this. Our true families— BLAIR HODGES: Because we're all human. MARIEL BUQUÉ: Yeah, we're all human. We're all flawed. We all err. We all say things that maybe come from a specific place, even if it's from a loving place, can be hurtful. We all cause emotional injury to others, because that's the human way. Now, when we're able to actually acknowledge that, what happens within us is that it actually creates a moment of grief that a lot of us are not prepared for. Because we've been denying that this family member or this family unit can actually have these deep hurtful characteristics within them. And as a result, it makes it so that we just delay the grief. But eventually we have to get to it. When we start realizing that the toxic relationships we've been getting into are mirroring the relationships we saw growing up, or that there are certain words we tend to say to our children—words that have been socialized and ingrained in our brain from how we were raised, but we never realized, “Oh my goodness, that's really hurtful and kind of cruel,” right? When all of these things start coming to the fore and we have these “a-ha” moments, we have to face the inevitable grief. And it's either we are in grief but we're denying and pushing it down, or we are open to the grief and are facing it head on and are saying, “You know what? My family is loving and hurtful. My family is nurturing and invalidating,” right? Like they have a mixture of characteristics. “And I myself, have been a person that has perpetuated things on both ends, and have also been a part of how this family has operated perhaps in dysfunction for a multitude of years.” So when we can actually step into an understanding of the true family we have in front of us, what I believe has been the biggest consequence of being able to enter that stage of grief and then just really feel the grief and come out on the other side, is that when we start having a lot of compassion for ourselves, for what we've had to go through, but also for the people that came before us, and the ways in which they've also been in their own suffering. It creates a lot of compassion. It doesn't happen for everyone. But it does create a lot of compassion for many people. BLAIR HODGES: And you talk about how the outcomes could be different. It might be something where you can reconcile with the relationship in an incredible story. It might be that someone's dead, they're gone, you can't reconcile with them presently. So you offer practices people can do—write letters to the to the deceased, or meditate on them, or whatever. Or it could be someone who's painful enough to where it wouldn't be safe to reconcile with the person. But you can still try to seek understanding and empathy toward that person, and try to heal in relation to them without having to necessarily come back together. So you're not prescribing the exact outcome in this book. It seemed to me that you were more interested

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Howdy, I'm Elliot, published by Elliot Billingsley on January 6, 2024 on The Effective Altruism Forum. Hi EA community, I'd like to formally introduce myself to this forum, where I've been lurking for a while but have been too timid to post until now, thanks to the encouragement of some. I first heard about EA through the Tim Ferriss Podcast in 2016. I still remember standing on the ferryboat crossing the Bosphorous while listening to Will MacAskill say things that were incredibly obvious, at least after they were heard. In the couple years that followed, I organized a local EA workshop, attended EAGx Berlin, and flew to San Francisco to attend EAG. I got involved with Students for High-Impact Charity, helping out on the periphery. I enjoyed lively conversation with EA Vancouver. And increased the usage of the phrase 'expected value' in daily conversation. That's about it. That was my EA Life Phase I. Half a decade later, I sat down with my wife and child during a Pentathlon in which every day you ask yourself the question: "What is the Most Important Work I can do today?" All of a sudden, it all came back to me. The most important things I can possibly do have quite clearly been described in EA. So I resolved in early 2022 to buckle up and take EA seriously. I honestly wasn't sure what my best option was, so I went with the most inspiring recent topic on the 80k podcast: Andrew Yang's Forward Party. I basically reached out and got named State Lead.I feel my experience with Forward may be a whole 'nuther post so I'll leave it at that. I also engaged in a lot of other ways, in large part thanks to EA Virtual Programs, which I really appreciate. But there's one person who had a huge role in my transition from an EA sleeper cell to a stupidly engaged one. That's Dr. Ben Smith. I swallowed my Ninja Lurker EA Forum personality (Never posts, always votes strongly) in order to write this post, for a specific reason, which I'll share now. Last fall, I launched a coaching practice with the intention of supporting the EA community. I asked some friends and acquaintances to take a chance and try my coaching out, and thank them very much. I now know my coaching helps people. So If I help EAs, I'm helping better, in theory, right? I want to test this theory! I'm going to EAG next month and even have a special cohort designed for attendees. If you're going to EAG, do consider applying, we'd love to have you. So that's my shameless plug. For any of you still reading, I'd like to say thanky (I'm from Texas, that's kind of how my dad used to say 'thank you'). I hope to write here more and learn in this incredible community. Elliot Thanks for listening. To help us out with The Nonlinear Library or to learn more, please visit nonlinear.org

Turn your data into actionable value with SWAT MAPS: https://swatmaps.com/Toby Kiers, PhD website: https://tobykiers.com/Toby's TED TALK: https://www.youtube.com/watch?v=NjwvaF3P_5Q&t=273sScientists are discovering incredible interactions between plants' roots and soil dwelling fungi called mycorrhizal fungi. These relationships are integral to how plants function, including of course, our crops. But despite their importance to fundamental aspects of plant development, there's still so much we have yet to learn."We know, for example, that the fungi, when it colonizes the root system, it can actually change the gene regulation of the plant, such that the plant is no longer able to access nutrients directly from its root system. It kind of creates an addiction onto the fungi that makes it so the plant is giving more carbon to get at the nutrients."That's Dr. Toby Kiers, an evolutionary biologist who studies these mycorrhizal fungi. She shares why this work is so important for biodiversity, for crop development, for soil health and for carbon sequestration. "We did some research that found that about 13 billion tons of CO2 are allocated every year from plants to mycorrhizal networks across the earth, so that that includes all kinds of mycorrhizal fungi, also associated with forests. But that's a huge number, right? That's equivalent to one third of the emissions from fossil fuels."The functions and strategies that these fungi perform in nature will blow your mind, and I can't help but wonder about the possibilities for the future of agriculture. Professor Toby Kiers is an evolutionary biologist who earned her PhD from UC Davis. She has been Professor and University Research Chair of Evolutionary Biology at Vrije Universiteit in Amsterdam since 2014. Kiers is famous for uncovering ancient biological markets that take place beneath forest floors, in which different trees and fungi barter for essential resources such as phosphorus and sugar. Kiers co-founded the Society for the Protection of Underground Networks (SPUN).

Welcome to another groundbreaking episode of Superhumanize, where we sit down with the legendary Dr. Joshua Levitt. Imagine this: a doctor who doesn't just prescribe pills but delves deep into the roots of your pain, combining the art of ancient healing with the precision of modern science. Dr. Levitt isn't your typical naturopathic physician; he's a trailblazer in the realm of natural medicine, a visionary who sees beyond the constraints of conventional healthcare.Think about the last time you felt truly listened to by a doctor. That's Dr. Levitt's realm – he's not just a healer; he's a listener, an innovator, and a real-life health wizard. With a degree in physiology from UCLA and a doctorate in naturopathic medicine from Bastyr University, he's got the credentials. But it's his over two decades of clinical experience, his role in shaping future doctors at Yale, and his pioneering work at UpWellness that set him apart. He has helped thousands of patients with natural solutions to common, chronic, and complex medical problems. His primary focus is on painful orthopedic and musculoskeletal conditions and helping people understand and treat their pain at the source.This episode isn't just a chat; it's a journey through the uncharted territories of health and wellness. We'll dive into the mysteries of joint pain, explore the potent power of herbs and nutrition against inflammation, and uncover the secrets of adaptogenic herbs like medicinal mushrooms. Dr. Levitt is here to challenge what you thought you knew about pain management, gut health, and the delicate balance between our mind and body.Gear up for a conversation where conventional medicine meets its natural counterpart, and that has the power to transform your understanding of health. Get ready to be inspired, to question, and to discover a new horizon of health possibilities.In this episode with Dr. Levitt, you'll discover:-What is "alternative medicine" and how can it complement, or even replace conventional medicine?...03:52-How does one go about navigating the dramatically different paradigms of conventional and alt medicine?...06:35-Are conventional docs searching for answers to unsolvable problems through alt medicine?...09:45-Josh shares success stories in his alt medicine practice...11:46-Nutritional and herbal solutions that can effectively reduce inflammation in the body...14:50-What are adaptogenic herbs, and how can we incorporate them into our wellness routines?...22:30-How do you know which wellness products on the market have a truly purpose-driven ethos in business?...26:40-How Josh ensures the highest possible amounts of bioavailability in his products...32:10-Potential downsides and limitations of relying solely on conventional approaches and not opening up to alternative medicine...41:23-Crucial factors in choosing a doctor who will more or less determine your long-term health...43:40-"It's tragic that the insurance companies don't place a premium on things like diet, exercise, etc."...47:30-A personal practice that has Superhumanized Josh's life...52:31-And much more!Resources mentioned:Up WellnessGuest's social handles:Instagram

Put AI to work on your farm: https://farmwave.io/Texas A&M Website: https://agecon.tamu.edu/people/fischer-bart/Southern Ag Today: https://southernagtoday.org/As we approach the end of 2023, one thing that many in agriculture thought would happen this year that hasn't is a new farm bill. "The farm bill attracts this outsized attention. It's carrying some baggage that probably was not envisioned, you know, 80 to a hundred years ago when this process was started."That's Dr. Bart Fisher, who spent eight years with the House Agriculture Committee, and today is a professor of ag policy at Texas A&M. The lack of a farm bill brought up a lot of questions for me about this legislation. Like what are the impacts of not having this bill in place? What causes these types of delays and are these farm bills which have been around since the 1930s even still relevant?"It's just incredibly important for the productive capacity of this country that we maintain a safety net for growers because it costs so much to produce."Bart gives me quite an education about the past, present, and future of the farm bill. We talk about some of the nuances to getting these bills passed, and what goes into these farm bills from support programs to crop insurance, to conservation and beyond, and we cover the impacts of the policies on farmers and rural economies. "Farm bills aren't written for the good times. They're written for the bad times. One of the challenges though is that even though they're written for the bad times, they're often written during the Good Times." Dr. Bart Fischer is a research assistant professor and co-director of the Agricultural and Food Policy Center in the Department of Agricultural Economics. His applied research focuses on solving real-world policy problems for agricultural producers and on anticipating potential policy changes for Congress to consider. Before joining Texas A&M University, Fischer served for more than eight years on the House Agriculture Committee in the U.S. House of Representatives. He was involved in every major agricultural policy development in Washington, D.C. over the past eight years, including the 2014 and 2018 Farm Bills. He is the 5th generation to be raised on his family's wheat, cotton, and cattle operation in Southwest Oklahoma and he continues to be actively involved.For those of you not real familiar with the farm bill: it's an omnibus law that is addressed every five years to provide an opportunity for policymakers to address agricultural and food issues. We will reference a few of the titles of the farm bill by number in this episode, so just so you have it fresh on your mind, we'll talk about title one, which is commodities. These are all of the price support and income support programs for the most widely-produced commodities that are produced. We will also talk about Title 2 which includes conservation programs and title 4 which is focused on nutrition and the SNAP program, which is formerly known as food stamps.

Join this podcast's Facebook Group: The Dental Marketer SocietyJoin my newsletter: https://thedentalmarketer.lpages.co/newsletter/[Click here to leave a review on iTunes]‍‍Guest: Mary Ann PruittBusiness Name: Mosaic MediaCheck out Mary Ann's Media:‍Website: https://mosaic.agency/Twitter: https://twitter.com/mediaMAPsLinkedin: https://www.linkedin.com/in/maryann-pruitt/‍‍Other Mentions and Links:MeatEaterNetflixGoogle Pay for ClickBing Pay for ClickHuluAmazon Prime VideoDr. ClarkSuperfans - Pat Flynn‍‍Host: Michael Arias‍Website: The Dental Marketer Join my newsletter: https://thedentalmarketer.lpages.co/newsletter/‍Join this podcast's Facebook Group: The Dental Marketer Society‍‍My Key Takeaways:Can you answer 10 questions about your target audience? This will help narrow down your marketing efforts.Don't be the turtle in a recession, do something to stand out from the competition!Outsourcing to a professional in marketing with save you valuable time and money.Having a specific strategy partner will help bring your marketing plan together.Make sure content you put out always speaks to your target audience.Social media platforms are NOT for targeting, they are for branding!‍Please don't forget to share with us on Instagram when you are listening to the podcast AND if you are really wanting to show us love, then please leave a 5 star review on iTunes! [Click here to leave a review on iTunes]‍p.s. Some links are affiliate links, which means that if you choose to make a purchase, I will earn a commission. This commission comes at no additional cost to you. Please understand that we have experience with these products/ company, and I recommend them because they are helpful and useful, not because of the small commissions we make if you decide to buy something. Please do not spend any money unless you feel you need them or that they will help you with your goals.‍Episode Transcript (Auto-Generated - Please Excuse Errors)Michael: it's time to talk with our featured guests, Marianne Pruitt. Marianne, how's it going? Great. How are you Mary Ann: today? Michael: I'm doing pretty good. Before we pushed record, you were giving us a lesson real quick on where you're located. Where are you? Mary Ann: Where you from? Yeah, so I live in Anchorage, Alaska.I'm not originally from there, but I live in Anchorage, Alaska now. We are a media firm that is covers the entire country. It's just, I just have the amazing benefit of being able to live in Alaska. Michael: I know I got really into Alaska when I was watching Meat Eater. I don't know if that Oh yeah.Netflix. Yeah. I mean, they're in Alaska all the time. Real quick, if you can let our audience know. Two quick facts about Alaska where Mary Ann: you're from. Two quick facts. The state of Alaska is almost the same size as the continental us. If you were to take the state of Alaska and put it in the middle of the continental US, it would touch coast to coast.People do not realize that and top to bottom. Oh wow. So Alaska is huge. Another quick fact. We are the more what number one ice cream consumer per capita. So who knew that? And then one more fact, we have more pilots than any other state per capita as well. Oh, wow. The Michael: ice cream wine.Mary Ann: Interesting. The ice cream one. Right. Number one highest consumer of ice cream. So you would think you love our ice cream? I, I think it's the lack of vitamin D in the winter, but maybe not. I don't know. Oh, okay. Maybe this is the theory. I think we just like our ice Michael: cream. Yeah. Yeah. Okay. Awesome. Awesome, Marianne, I appreciate that.If you can tell us a little bit about your past, your present, how'd you get to where you are today? Mary Ann: I'm an East Coast girl originally. But I actually started in marketing and in media at a very young age. So I was 16, 17 years old. I started on the graphic design side, believe it or not.And this was before everything was digitized, so you had to take an actual picture, scan it in, use it that way. And that's actually how I got into marketing. I worked in a tourism shop for a while designing various gadgets for tourists and various things along those lines. It was a lot of fun, but I fell in love with media at a young age, getting into media and doing media, planning and strategy and all the above, and I was very fortunate to get into it really young.So I worked my way through college. Was able to find the fact that I loved marketing and economics, and that's amazing how that goes with media and especially in today's world cuz we are all data nerds. When you are into economics and when you are into media, you have to understand and love your data in today's world.So, the economic side of me definitely in the statistical data and all those things, I'm definitely a stats nerd. I absolutely fell in love with that so, I started my firm a little over 12 years ago and really focus on media. That's all we do. And we got into programmatic media early and that's where we are now of being able to be one of the leaders in programmatic and being able to offer those services to multiple, multiple different brands and multiple verticals.Michael: Real quick, rewind a little bit. Marketing and economics. Break it down to us. How does that go? Hand Mary Ann: in hand? It, it's so funny cuz you don't actually think that it does Uhhuh. I did my thesis on recessional recovery. On the economic side. Well, guess what? And the, one of the key things of recovering from and being a company that is recovering from a recession, Is actually your marketing plan and the two go hand in hand, and we don't think of them going hand in hand.We think, okay, marketing's over here. Economics is over here. Well, both of them are in the business sector and both of them are in that umbrella. If we actually bring them together, the knowledge that you learn in and I, I call marketing the marketing bridge. So we have all of our different pillars, everything from your name, from your website all the different things of your clients being able to find you and your potential clients being able to find you.That's your marketing bridge. Well, media is one of those pillars and in economics, and if I look at that side of it, statistical data. Is a huge part of economics. That's what you're studying. You're studying statistics, you're studying that, those pieces of, especially in a recession various recoveries, various things that you can do with it and what better to go together.Media is in marketing and the statistical data falls into economics and marketing as well, and that's where you have that bridge. But you have to have that bridge for you on your marketing has to have all those pillars filled and economically. We need to look at no matter what. And a lot of people are accidental business owners.They go into a career off of something totally different. They either want to be like you're listeners, they wanna be a dentist, they want to be a medical practice, but they're never taught actually how to be a business owner. And when you think of it as having that. Bridge with all those pillars. The economic piece is there too, because depending on how the economy is doing globally and locally and nationally that's gonna be how your business is gonna do.So what can you do? What are tactics and strategies that you can do headed into a recessional prospect or something that's gonna take place? Michael: Oh, so what are some things we can do? Because we're like, in that situation coming in, a Mary Ann: lot of people are So, key thing first, own your space. What is your, what is your niche?Where are you, who's, what's your vertical that you're gonna be in? But huge piece of it is also, so know that audience, know your audience and get to know it better. And when you get to know your audience even better to that level where you can list 10 things about who your ideal customer is, and you can have that full line out there to be able to do it, you will be able to strategically build content that will reach them.You will be able to have your ad buys be more strategically done. One thing that I think is really imperative actually, especially in the dental space, in the dental practice and the medical space, is that we don't actually think of media as being a positive necessarily paid media specifically, because, you know, if I'm good enough as a dentist or if I'm good enough as a doctor, I don't necessarily need to have media.Right. But no, in reality in today's world, you have to have that presence out there. So how do you, how do you start building everything that you can to recover recession, even before recession starts to happen? Start building content to your, to your audience. So know that audience. Start building content to the audience and strategically start doing paid advertising with it.I call using the paid portion of it and the paid media side of it as leapfrog. So you're gonna wanna do your ppc. So that you're showing up on searches, you're gonna wanna do some programmatic targeting. So programmatic targeting, cuz a lot of people get confused on what programmatic is. Mm-hmm. But programmatic targeting is it's a bidding process.When I start in a media, you used to do an R F P and say, okay, TV radio station, gimme what your rates are, put the plan together and go from there. Now it just automates it where now I don't have to get a rate card from a website. I go in and I'm bidding on the individual. That I want to see the ad. So I'm bidding on that impression and I'm able to target that impression based by my audience.So the more I know my audience, the more I can bid towards that audience and bid for that impression specifically to them. And the more first party data you have, you can also target in that manner. Do you know who, do you have email list? Do you have things that you can really target with? Do you have addresses that then we can do IP targeting with?There's various things there. So. The one, the very first reaction of recessions are happening and recessions are about to happen. Mm-hmm. Is everybody just retreats back in and is turns into turtles and we're like, we're just gonna hold onto everything. Mm-hmm. And in reality, this is the time that you can play leapfrog and actually go above your competition, stand out a little bit more.You just have to be strategic at it. Michael: Gotcha. Okay. So programmatic, you mentioned something called R F P. What Mary Ann: is that? Yeah, an RFP is request for proposal. So that would be, that was, that's the old school way of doing media. There's still ways that we would do it where you you need your television, you need your radio print, outdoor, but a lot of that's starting to move into programmatic, so you can start bidding outdoor programmatically, some TV and some radio.You're bidding programmatically as well, but, some of the old school ways of doing it. If you need those traditional platforms, which I'm a big believer that traditional is not dead. Mm-hmm. We have traditional and digital and you ha you just need to know how to do the two together. Michael: Gotcha. When it comes to traditional marketing, what falls under that Mary Ann: in your eyes?So, tv, radio, print, out of home, those are the ca billboards, various things there. Buses that falls into traditional, except for now, programmatic wise, we're able to do a lot more with that, with digital billboards and digital things that are out there that we can bid to be able to actually programmatically bid that as opposed to having to do it on the traditional front.Michael: So how can we use both? Mary Ann: here's the key thing. You need to use both. Mm-hmm. So again, I'm gonna go back to get to know your audience. Who is your audience? Who is it exactly that you want to reach? And we're gone in the day of thinking of just a demographic. know in a dental practice and various things that you're thinking, I just, everybody is my.Ideal client, right? Because everybody has teeth. Well, okay, but who, when you see your patients come in, who do you know is that sweet spot client? Who is that person? That is the individual that you go, okay, that is who I want to duplicate to have in my chair all the time. Somebody who, who is easier going, maybe has a full family, that you're gonna get multiple cleanings a year out of.What is it that you want to do there? Who is the decision maker in the household? What are the things that are taking place? Identify clearly who you want and then from there you're gonna be able to strategy reaching out into all of these different audiences that you're looking at. But it's not a demographic anymore.Okay, so we're not looking at adults 18 to 50 fours who are reaching No, because I am gonna reach the 18 year old differently than I am the 54 year old. I'm going to more strategically say I would like to target women who are mothers at the age of 35 to 45, have two plus children in the household who maybe are employed as well have, you're giving those persona.Identifications as opposed to just a demographic, a wide net, you're actually narrowing it down into a persona and an individual targeting system that you're looking at. So Michael: can we come up with a plan for, for that, like specifically the example you gave us, like, well, let's just say the patient I want is.The family, right. But I'm gonna target the, the mom or the woman. Right? And from that point on, she's making maybe like, you know, she's the other working or together as a household. They're making 150 k plus they have two children. What now do I do as far as when it comes to traditional and digital? I.Mary Ann: So would I would a couple of things here. So unless you as a practice are investing in the multiple tools to know where she is, I would find a great partner. So there's a difference between a partner and a vendor. A vendor would be somebody that really goes into that is a TV station, that is a radio station.Those are great people. I love 'em. They're great people. Nothing bad there. However, in this type of targeting, You want a partner that is similar to like our, our firm, where you come in and somebody can outline for you and help you. You say, okay, here's my ideal customer, and then. You're looking for a strategic partner at that point that can say, okay, then I can help build out your plan for you, and here's your strategy, here's your plan.This is where we're going, and we're gonna base it off of what budget you wanna spend. Various things there. So there's that difference. Huge difference between the fact of having A vendor and a strategic partner. Strategic strategic partners are night and day. They're gonna be part of your team.That's how you should be seeing them as part of your team. So when you're building this, you're looking at, okay, I wanna build my, plan towards a woman that's 35 to 45 years old. So I'm gonna look in that. She has, she's a family, family of. Four plus, you know, hold household. She works, this is her household income.On the programmatic space. I'm actually going to be able to target based off of her income, based off of family size, based off of which neighborhood she lives in, which neighborhood she doesn't live in, what kind of car she might drive. That might be something I would put in there. Various activities.Is she a gardener? Is she. Does she like to run as a hobby? Very. Is she outdoors? What types of targets would I look at? That I know her hobbies are you don't have to go that deep. You are fine to not, you want to know who she is for which in which you're trying to target. So the family of four, the age range where she's gonna be.So I'm gonna actually build a model about this persona. Mm-hmm. Find out where she is, find out where she's going to be, and then from there I'm gonna figure out the programmatic tactics that are gonna work best for her. I'm gonna make sure that we have our p c, our Google and our Bing taken care of there on that front.So if she's searching for us and she's looking for a new dentist, maybe she's even new to the area. And that's another layer of something that I wanna put in there. And making sure that it, when she's Googling, she's able to find it. And then on the traditional side. So that's all my digital stuff.I'm gonna look programmatically, where is she? Where is it display? Is it video? Is it connected tv? What is she gonna be on? A lot? And I will tell you right now, she will be on streaming. So look at TV in that manner. And then I'm gonna go over here on the traditional side. Where is she gonna be? Now that's gonna depend on the market that I'm in.So it's gonna be varied. And this is why a strategic partner is also important because they will have access to ratings. They will have access to information like in your market in Los Angeles. I'm gonna have access. I have access to all the numbers. I have access to all the information that I need to have.To see who's watching what, who's listening to what, what billboards have the most traffic, what various things, what's the best place for me to place it. So in that sense, depending on the market, TV's probably not going to be your best option unless it's a live event that she's gonna listen to and watch.Okay. But live events mean local news. It means sporting events, various things. If her kids are gonna be, if if there's a live events that kids are playing or things like that, then she might be a part of that. That's where your TV's gonna come in. When it comes to radio, that's probably where you're actually gonna reach her the most.So you wanna make sure you have your digital portion. That, that's where you're reaching her the most. But then you're gonna back it up with your radio to make sure that she's getting high frequency over and over and over again. Cuz believe it or not, local radio is still very highly consumed and people listen to it.People love to, especially women during covid, we saw starting to turn to local radio to find out. what the counts were in their county, what were various things that they needed to know? What were the new regulations? And these are habits that developed over such a quick period of time that kept going, that their habits are still there.So radio's gonna be your best option. And outdoor, those are gonna be the two key things that you're gonna bring in with that. With that digital plan as well, because you wanna make sure that you have high frequency and that they're seeing, they feel like they're seeing you everywhere and they're hearing you everywhere.It's an omnichannel approach, but you don't have to have the budget spread so thin that you're just condensing it into one area and you're making sure that your digital and your traditional are working together. Michael: Hmm. So it feels like, man, they're everywhere, but really it's just targeted. They're going after that specific person now.Real quick, how do you get that information when it comes to like, oh, okay, everybody in, I know all the ratings and stuff like that. Is there a place or you have to subscribe to 'em, Mary Ann: you have to pay for 'em. Um, So that's why having a strategic partner is really important because you're having to subscribe, you're having research tools, various things we use and utilize.This is all we do, right? So just like you would not want me put a filling into your tooth because I'm not a dentist. You don't want me to do that, right? Mm-hmm. So as dental professionals, You guys don't need to do the media. You don't need to think about that side of it or that strategy side of it.Outsourcing it actually probably will not cost you any extra money to have that portion of it. So if you're looking at having strategy, having various things, your return on investment is so high, but also the actual placement. There's various ways that it's actually not gonna be, it's negligible in comparison to you doing it yourself.When you think about you, let's say you're a dentist that's owning, that owns a practice, and your time and your team's time, that is going into your marketing or your media. That's a return on investment where they can be in the office doing other things. They can be doing it. They can be in the office focusing on the patients, making sure that that portion is there.Outsource that part and find a good partner that you can trust and be a part of and work with, because that's where it goes hand in hand. That's where you need to know in today's world, collaborating together is the best way to get the most outta your business plan. Michael: I like that. So then when it comes down to this, let's just say, Startups, right?It's like a super lean budget. And then they're like, Marianne, like, you know, I want to, I wanna do this. My budget is like bare, bare minimum. Yeah. Can we still do that or Mary Ann: no? Absolutely. And you should. So, knowing and starting even with a bare minimum budget, you should be looking at what are my marketing efforts that I'm gonna go into it.You have to see it as an investment because if you are a startup, your brand recognition is zero. Nobody knows who you are. Nobody knows what you're doing. Nobody knows what your specialty is. Nobody has a clue, right? So you have to identify and know, all right, I'm going into this as a startup, I need to make sure that I am building a plan there.Even if it's minimal, you'll wanna make sure that you're investing somewhere. So, that's again where a good strategic partner comes in because they'll be able to help you and say, okay, hey, how do I make sure. That I'm doing what I need to do with this budget. Here's this budget, this is what I have set aside.What can I do with it? But that's where a good strategic partner will be able to say, okay, here's a few options for you. It's not necessarily just cookie cutter. This is the only thing for you. It's making sure that there's a few options. Michael: Okay. I like that. And now, Maybe this has happened to you before, but you know how sometimes you're like, this is my target, this is who I want to get.You get them, but then, you know, other people start hearing Yep. Maybe not in that age range or anything like that, and then they, they come in and you're like, oh, I love this type of patient too. Yep. Different generations, right. Is there a specific type of marketing for that? Yes. Or do we have to change it, or how does that Mary Ann: look?No, no. In fact, you don't wanna change it. So you want to stay steady where you are. And I called that your baseline plan. So that's your baseline targeter and who you're targeting. So you're, you're gonna target this baseline plan, who is your ideal customer? From there, you can have multiple targets and multiple personas that you're looking at.So if you start to see, hey, This audience segment is actually influencing the family as well. And now I'm growing as a firm. Now I'm growing as a practice. I actually have a little bit more money that I can invest in this target as well. So it's a layer. So you're gonna start with your foundation, and especially if you're a startup, start with that foundation and then you're building to get to that point, right?And you're gradually adding things to it. When you're marketing and your media budget start to shrink back. As a practice, no matter how long you've been in, you really need to look at that and assess it and decide why am I wanting to shrink back? Do I think that it's actually because I don't need any more customers, that I don't need any more patients?Well, in reality, you actually, the longer you've been around, the more you actually are going to have to promote to get new customers and to get new patients. You have to keep it going. It's not something that is a set and forget it, and it's not something that you start and pause. You actually need consistent branding and consistent media out there for you especially in today's world and especially with how many competitors you will have in a market.Michael: Mm. Gotcha. Okay. I like that. And then I know like a lot of the times we tend to, you've seen it, right? Traditional has been evolving into like what it is now, digital and things like that. People are on social media and you know, all these other platforms and everything like that. Is there a specific one where you're like, Hey, look, you need a focus.Everybody should be focusing on this media right now, at least, or is there a best one? Worst Mary Ann: one, each one has its strengths, right? So it depends on its goals. You're looking at traditional, I talked about traditional, a little bit of what the strengths are there. TV you're looking at live events.That's where your strength is. If your target audience is men, television still is pretty highly consumed by men. Mostly in the live sports arena, and that's where you're gonna be. Although we see an increase in female numbers too with live sports. So across the board, that's where you're gonna see that.And then in radio it's more informational. So your weather updates, your traffic updates, those types of things that you're gonna see that are key for you to be a part of in radio. Now when it comes to programmatic, right now, you, no matter what, you need to be looking at programmatic, you need to be looking at Google p c being p ppc, very sync.So, paper per click and seo. That's what you need to be looking at. But programmatic is where that is the future of media. That is the future of how we're consuming when I started my career, well over 20 years ago. Programmatic was not an option. Obviously, it wasn't anything that you could really do.You had, your f. Few options. It's pretty much four. That's it. And that's what you were gonna buy in every market. Now you have so many options of what you can do and go after and target. So programmatic is definitely something that you need to be looking at. Social platforms, I'm going to say this as loud as I possibly can.Social platforms are no longer a targeting tool. Social platforms are a branding tool. Overall brand recognition period. Do not try to use it as a targeting tool. There is no longer availability or possibility with cookies, with various things on Facebook that you cannot target the same way you can. We can do lookalike audiences, various things there on social media.Mm-hmm. But that's not a targeting tool like it used to be. Programmatic is now your targeting tool. That's where you want to use. You're targeting and that's where you wanna use your focus, not social media. So each one has its strength, each area has its strength. But if you're not doing something digitally, you definitely need to refocus and do something digitally.Hmm. Michael: Okay. So when people say sometimes, cuz there's a lot of types of like. Influencer marketing on social media, then people I know we, we know a couple dentists who they say like, yeah, you know, my new patients from like Instagram. That's more cuz of like brand awareness Mary Ann: or It is. It absolutely is. So it, there is nothing wrong with that.And there is nothing wrong with influencers. We do a lot in the influencer space. There is nothing wrong with that. You just wanna use it correctly. It is not the same targeting tool that it once was, and that's what you need to think about it. If you have first party data, if you have emails, you have various things there.Algorithms are gonna show how things are targeted to that and what. In that sense where the algorithms are gonna pick it up, but you as a marketer are not gonna be able to use it the same level that you've done before. When and when I'm talking targeting, I'm talking like the multiple layers of targeting of who my ideal customer is.Not just broad, I'm talking very, very in depth. That's where programmatic comes in space now, and that's where that it's starting to take over in that area. Instagram's a great place for you to be and if that is where you're getting most of your customers, great. keep budget in Instagram, keep budget on Facebook.However past that, add programmatic for that additional targeting of that customer and where they're gonna go. Again, it's that omnichannel approach cuz now I'm able to actually target them in even further and to be able to go down that path with programmatic. Michael: Okay, so you said use it correctly. Social.What, what have you seen where you're like, oh my gosh, you're using it super, not even good. You know what I mean? What are the pros and cons Mary Ann: of that? So you wanna make sure, again, you're thinking brand recognition more than you are. Very specific. Targeting and who you're, who you're looking at, but your content still needs to be specific to who you wanna talk to.That's where, so yes, it's overall branding. However, your content needs to be driven to that target audience, no matter what platform you're on, because if they do see it, if they, if it comes across their path, that's where that targeting. Message point comes in. So when it's done poorly is when it's a very broad message.Mm-hmm. As opposed to a very targeted message, meaning your message itself is talking to a specific person. Even if you're using a broad platform or a branding platform when it's done best videos work really well, more than still images. We know that, we know statistically speaking. And 15 seconds or less is what you wanna do.And what you can look at too, if you are doing videos, if you have that kind of content that you're putting out there, absolutely. Look at adding a programmatic pre-roll layer to that, or a connected TV layer to that, because that's where you're gonna target your audience. Audience even further. Michael: Okay?When it comes to tv, especially streaming, how expensive is that? Mary Ann: So now programmatically when it comes to streaming, that's how you're getting streaming tv. for the most part, so you do have your local TV vendors that you can still work with that are various things. I would actually suggest not buying programmatic through them.I would suggest finding a strategic partner to buy it through that has a direct seat on a d s DSP and that you're able to use use that instead. The buying directly through the vendor, your cpm or cost per impression, is usually, typically higher and not necessarily, as quality. It can be, but not necessarily.So when you're buying it on the programmatic side, you have a little bit more controls of what you can do, but you are buying it by the impression. So it actually buying streaming TV can actually be more affordable than you would think. Specifically. If I'm gonna take a step back and not talk just tv, connected TV or O t t, which is over the top television. If I'm looking at pre-roll, that's actually more affordable than people realize or recognize. So those are 15 seconds, 15 second ads that are gonna run before another ad or are gonna insert site an ad. Right. So pre or mid-roll. And those are the ones that you also need to think about. It's not as expensive as you would think.Digital has allowed it to be more affordable that we are able to build budgets based off of what your size is. Based off of what kind of budget you have to actually make it a strategic plan no matter what size the budget is. Michael: Oh, actually, okay. So that would be like Hulu, places like that, right?Cause I don't know if, does Netflix even have commercials or no? I don't know. Mary Ann: Not yet. They'll, they, so you have your Amazon Prime, so you've got your Hulu, you've got your Amazon, but you also then have, if you're a direct seat on A D S P, you have anything that's streaming all the various.There's tons of streaming outlets that are out there. Michael: What, what does D S P stand Mary Ann: for? D S P is demi demand side platform, and that is the bidding capability that takes place. It's literally, software and automation that allows you to bid in the programmatic space. And it's, it's very expensive to be, to don't.As a dental practice, I would not suggest you trying to do it yourself because, and find a partner that is a direct seat and that's a question that you wanna ask. Are you a direct seat? And that way you have that capability of having that team because it's a good couple million dollar investment to be able to do that.But you wanna make sure that you have that that capability because then you have somebody, if they've built their team correctly, they're optimizing, they're doing various things for you on your behalf every day. Michael: Wait, so it's a million dollars for the practice or no. For you, Mary Ann: for the, like, you, so, so to be a direct seat is not, it's not.It is not cheap. It is, it's okay. Gotcha. Gotcha. So find a partner that's a direct seat. Mm-hmm. As opposed to you trying to do it yourself. Yeah. I would assume you'll, you'll take advantage of the fact if you don't, if you don't have a large budget, and even if you do have a large budget, but it's not in the millions and we're talking millions, not just a million, we're talking millions.If it's not in that category, then you need to think about what kind of strategies you wanna have in partnering with. Being able to get that done. Plus you have to have the team on top of it to optimize and to be able to do all the bidding and to be able to do the work. Michael: Yeah. Yeah. Cause I know, yeah, especially if you're starting up or anything like that, it's not gonna be in the millions, right?Like the No. Mary Ann: Correct. And nor should it be. You don't need to be in the millions. Um, So find a partner that is that direct seat for you that is able to, they take their volume. So if you work with us, we take our volume and we, we do. Millions and tens and twenties and you know, we are over a hundred million at times.That's what, kind of work we do in placement. So take the advantage of our millions and be able to place. Mm-hmm. So take advantage of how much we are placing. On behalf get on our backs of being able to negotiate that for you and use our leverage overall of what we're able to do, as opposed to you trying to spend a couple thousand dollars to be able to get the same kind of leverage, you're not going to.Michael: Yeah. But I appreciate that, Marianne. I appreciate that. Like we can tell you, this is who my, this is who I wanna see. Right? And then you can kind of create something and then say, this is the routes we need to go through. Instead of me going like, I want. You know, Google ads and then at the same time, I, I want social media marketing and they're like, okay, it's gonna cost you this much and this mu, you know what I mean?Kind of thing. Yeah. It's a different Mary Ann: approach. It's very stressful actually. So when you are starting a practice, especially a startup, but even if you're mid practice, if you're a few years in and you're looking, okay, we're about to hit a recession, I need to revamp and rebrand, whatever it is I need to do or just retarget of where I need to be.Having a strategic partner that can outline all of it for you is better than you going, Hey, social media person. Hey Google person. Hey and hey, programmatic person. Hey TV person. That's stress on you and your staff, where that can be you providing more services to your patients, your staff, providing more services to your patients.It's more efficient and it's, it's be, it's offering better efficiency for your patients, but it's also a better investment for you to be actually working with a partner to get it done as opposed to distributing it and, Just you trying to keep track of all of it or having your own in-house person. The other piece is having your own in-house marketing person.That can be a benefit. However, at the same time, you wanna make sure that you're, you're still doing your media practices and the media things that you need to do because you're gonna lose your audience. You need to stay consistent in that, your in-house person needs a strategic partner in media.Media is very specialized today, and you still need that in-house partner for your media. Michael: Yeah, I agree. So then what can a dentist do today to improve their marketing? Mary Ann: So first, evaluate it, look and see where it is. If you're a startup. Make sure that it's included in your plans. Make sure that you market the media portion of your marketing plan is there and make sure that there is budget set aside for it.But if you're, if you're a practice that's been a practice for a couple of years, make sure that you reevaluate regularly. So look at it and say, okay, every year, what options do I wanna look at? What do I wanna make sure I increase? What do I make sure? Where has my audience shifted? What are various things that I need to, I do, I have my foundational audience and I need to maybe add some layers on top of it.So reevaluate. Find that partner that can help you evaluate, find that unbiased and treat that partner like they're part of the team. That's the key thing. A lot of times that relationship and where it doesn't go as well is when you're looking at the partner almost like, oh, you're just a check. I have to cut.Mm-hmm. And in reality, don't think of it as just a check. You have to cut it. Think of it as that's what's getting customers and patients through my door. That is a funnel process that's taking place and. You, if you feel, eh, that's just a partner, that's just, that's not a partner, that's just a check. I have to cut, reevaluate that relationship as well.Reevaluate. I want a partner, I want somebody who I feel good about it, but also make sure that you have an open heart to have a partner with it. Not to just say, Ugh, you know, and have that, make sure we're your mi your mindset's in the right place. frankly, Dentists have a huge opportunity in their media and their marketing.Mm-hmm. Huge opportunities because there's a lot of targeting that you can do based off of dental habits based off of various things in the programmatic space that you can look at and say, you know, where are, what are some things that they've done habit wise over the last year, a couple years that we can target.There's blueprinting where you can even target. Competitors locations for ads to be served about you. When somebody walks through a door you can also use blueprinting to track people coming into your door. How do, how are they coming in? How is that happening? So on the digital side, there's so many options and dentists have huge amounts of options in that space.Michael: Okay. I like that. It, it is interesting you say that. I, I always wanted to know, like from the agency side, from you, especially working with practices and things like that. Where do you see the ball being dropped when it comes to like, Hey, you know what I, and then they may, I mean, maybe it could be the agency's ball or maybe it not, you know what I mean?So where do you see the ball being dropped? Mary Ann: So I think the ball is being dropped when in. I can completely understand this because I'm a business owner, right? And I'm running a business myself, and at times as the business owner, which you as the doctor of the practice, if it is your practice, you're the business owner.And sometimes we can be distracted by the business portion of it as opposed to, okay, what is our marketing? Which at the end of the day is what drives our sales and gets people in the door. So when you have that meeting with your partner once a month, once a quarter, whatever it is, that's set up for you.Take advantage of that time. A lot of times where the Dr. Ball is dropped is when the dentists or whoever it is that's marketing just sees it as the marketing meeting for the month where that person is only answering to them of telling them, updating them. No. Take advantage of that partnership time of the, I'm thinking this, I'm thinking this, I'm thinking this.Take advantage. Have notes. Be prepared yourself, not just them. Be prepared for you. Now that being said, On the other side of it, if they're coming to your marketing meetings and they're not prepared, they're not showing reports, they're not showing insights, they're not showing you things of what's been taking place, you need to evaluate that relationship as well.So there, it's both sides of the coin here, but you have to do multiple things, um, to be able to do it. You as the doctor, need to be prepared at that marketing meeting to ask tough questions and to write them down, because in between, from meeting to meeting, you will have thoughts, oh, I need to talk to so-and-so about that.I need to talk to 'em about this. Write them down. Have a marketing list and a media list for your partner and for your team. And then when you're in those meetings and when you're in there, you're prepared, you're ready to go. And you can say, okay, I was thinking this. I was thinking this. I was thinking this.And you'll get that collaboration back and forth. So where I see the ball drop the most is doctors that are checking the list as opposed to wanting a partner that will collaborate with them. Find that marketing strategic partner that's going to collaborate with you and work with you. Take advantage of that.When they are sitting there for that meeting with you, take advantage of the fact that they can collaborate with you. Michael: Okay, I like that. Now these next questions are just to get into the head of someone who isn't totally involved on the clinical side of dentistry. What would you Marianne like to see more from a dentist?Ooh. Mary Ann: So I think where I see it go well is where every dentist, I think mm-hmm. Wants it to be, well, I go to Dr. So-and-so and I'm not going anywhere else. That's Dr. So-and-so where you trust them so much that they're not, they are not gonna switch. Mm-hmm. Where they don't wanna see is the sale is hard on them, right?So they don't wanna see, Hey, you're a new dentist that I've never gone to. I'm here, but now all of a sudden I have. Four cavities and I need a crown. I'm very confused. Where six months ago I didn't need any of that. Can you explain why? So you have to approach if there's a need and if there's something that is there.Automatically people kind of question things. We are, we as human beings analyze, we overanalyze, hence actually why media consumption is at an all-time high. Because in Covid we analyzed everything and we wanted to gather information. That's what we do to survive, right? Mm-hmm. But in this case, When you, when I can trust my dentist for anything, I don't care what my dentist is like.I have that kind of a relationship personally with my dentist. Mm-hmm. No matter what he says to do, I will do it. And because he's telling me that, and I've trusted him for years in that, I've had dentists in the past where I'm like, Hmm, I don't trust that. I don't like it. I'm not sure it's there. Right.Whether or not that was real. But in reality, it's how you talk to your patients and it's how you communicate to your parent patients and explain to your patients what services they need that is gonna build that trust. Don't underestimate the the message when you are talking to your patient when they're in the chair.Don't underestimate that when your technicians and your hygiene technicians are talking to them in their chair. Don't underestimate that communication and how important that form of communication actually is. Are you, as the, are your hygienists getting to know your patients well? Are they getting to know the personal side of their life?Are they, they're in the chair for a while? Yes. Your hands are in their mouth, but they're in the chair for a while. There are things you can get to know. The hygienists that AC that usually are the best. Talk about the patient. They don't talk about themselves, they talk about the patient, and then what information is that that can then go to the doctor and then the doctor gets to know the patient.Right? That's where, on that side of it, don't underestimate the client relation side. Think of your patient as a client, not just a patient that is a client that you wanna have returned customers from. Mm-hmm. Ok. And they're the biggest referral. They're the biggest referrals. They will refer you all day long.Michael: Yeah. No, I really appreciate that, that that's, that's true. When it comes to the two that you mentioned, like the practices, what were you noticing with the dentist where it's like, I guess the communication was, was completely different. Mary Ann: So I'll tell you, and my, my dentist now, his name's Dr. Clark, love him.Love to give him a shout out whenever I possibly can. That's my personal dentist, right? Yeah. And he is a phenomenal communicator, but he tells me, Hey, this is what we're seeing. This is what's going on. This is where things need to be. My whole family, we all trust him in that because of how he honestly communicates, to me, he makes me feel like, okay, I understand, and that's what's really important as opposed to where I've had doctors or dentists.It's not just in the dental field, it's all across the board. This is what you need and this is why, and it's not even, this is why it's, this is what you need. And a lot of patients are confused because it's not their profession, it's not what they do. And as dentists and as medical professionals, take a step back and remember, your patients are not dentists, your patients are not in the dental practice, they actually don't understand.Mm-hmm. And nor should they understand they're hiring you for your expertise, for you to explain it to them, for you to tell them why their son has four cavities. It stinks. We've done, we've even done, we've done the fluoride treatments in the past, but this is what's happened. He's six, this is, it's his baby teeth, you know, whatever.Explain all those things to them. They don't know, and you're assuming that they know they don't remember. You are the one that is the expert in the room at that point. Own that expertise. Just like how when somebody comes to me and they're a dentist and they're a dental practice. Own the fact that in media, you don't have to be the expert in that.And that's okay. I should be explaining it to you. My team should be explaining it to you in that, and in that mindset. Yeah. Michael: Okay. Okay. And so the next question is, what do you hate or dislike about dentistry? Ooh. Mary Ann: Well, nobody likes to get any kind of certain treatments done, but mm-hmm. I'll tell you this though.I mean, if you've had, and I've been very blessed with good teeth, knock on wood. and still in my forties only have had one cavity, so I'm, I'm happy with that. So, I mean, I'll, I'll be, I, I take that, I'll, I'll wear the little badge of pride, although I'm not as good as my husband who has never had a cavity.Wow. But whatever. Not fair at all. But anyway, he says it's because of the fluoride and the water in Anchorage. He grew up in Anchorage. But anyway, so that being said, things that you hate, I think it is that bad communication. That's where it's always gone wrong for me with any type of medical practice or any kind of dentist.And this is me personally, If there's not that good communication, that clear communication that makes me feel safe, that makes me feel like I'm doing the right thing for my health that is clearly communicating that that's what I don't like. That's where, and frankly, that's no patient likes that.Michael: Okay. Gotcha. So no, kinda like just bland communication where you feel like, all right, we gotta get in, get out, boom. Kind Mary Ann: of thing. Yeah. You don't wanna feel, you don't want to feel like cattle moving in and out. Mm-hmm. And. There, there are. Now I will say this, there are some dental practices that have worked really well and efficient of getting people in and out, but there's still moments for that personal touch so that you can get people quickly in and out, but them still feel like they're getting that customer service or that attention that they want.They want that attentive acknowledgement of what they're feeling, what they're seeing, what's going on. Michael: Gotcha. Okay. And then, so what do you absolutely love about dentistry? Mary Ann: What do I love about dentistry? Mm-hmm. Actually, the fact that you can build relationships and long-term relationships within dentistry.So another thing I love about dentistry is the things that you can absolutely find out with the health of the body by finding out what's going on in the mouth and people. Don't. They just underestimate and average patients don't understand that there are so many different things that dentists find and save lives every day, and people forget about that.They don't know that they don't recognize it, but if you actually get into people's stories with heart disease or various things, they can tell you, and those are stories for you as dentists to be telling of, he saved my life because he saw this. And he saved my life because he saw this. Mm-hmm. That's a big deal.Those are things, other things that are happening in the body that dentists can actually identify and send them to a great expert outside of that. Michael: Yeah. Awesome. Wonderful. Maryanne, thank you so much for being with us. It's been a pleasure. But before we say goodbye, can you tell our listeners where they can find you?Mary Ann: Absolutely. So you can go to our website, which is mosaic.agency/contact. That comes directly to my, to my email. So mosaic.agency/contact. You can find me on Twitter at Medium apps. Follow me. We put out tips every day. And information every week. You can also, if you email, if you go to mosaic.agency/contact, you will be able to get your email added to our email list.We put out email blasts every week that give information on media and various things that are going on. And then find me on LinkedIn. I love to connect uh, Maryanne Pruit, and you'll find me right there. Mosaic Media. And we, I love to connect. I love to brainstorm. If you have questions in your dental practice of how is your media working, if you want a free assessment, let us know.Michael: Awesome. So guys, as always, that's gonna be in the show notes below, so definitely go check that out. And Marianne, thank you so much for being with us. It's been a pleasure and we'll hear from you soon. Mary Ann: Thank you, Michael. I really appreciate it.‍

You can also listen to this episode on Spotify!Did you know that all children, regardless of genetics, are at risk for substance abuse?Jessica Lahey is a New York Times bestselling author, mother, and parent educator on teen substance use. Her most recent book, The Addiction Inoculation, is a practical guide to help children grow up to be healthy and addiction-free. On this episode, Jessica sits down with Dr. McBride to discuss her own path to sobriety, the myths about substance abuse in adolescents, and how to help kids feel comfortable setting healthy boundaries. This is a must listen if you're looking for ways to talk with your kids, grandkids—or yourself—about alcohol. Feel free to share this episode with others who may be, too.Join Dr. McBride every Monday for a new episode of Beyond the Prescription.You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.Please be sure to like, rate, and review the show!Transcript of the podcast is here![00:00:00] Dr. McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor for over 20 years, I've realized that patients are much more than their cholesterol and their weight, that we are the integrated sum of complex parts.[00:00:33] Our stories live in our bodies. I'm here to help people tell their story to find out are they okay, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my weekly newsletter at https://lucymcbride.substack.com/subscribeand to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So let's get into it and go beyond the prescription.[00:01:01] My guest on the podcast today is Jessica Lahey. Jessica is a New York Times bestselling author, mother, longtime teacher and educator for parents and teens on the subject of substance use and overuse. Her most recent book, the Addiction Inoculation, is a crucial resource for anyone who plays a vital role in children's lives, from parents and teachers to coaches and pediatricians. Helping raise kids who will grow up healthy, happy, and addiction free. Jessica, welcome to the podcast.[00:01:35] Jessica: You are so welcome. I'm so happy to be here.[00:01:38] Dr. McBride: I'm really happy to be here too because you and I were talking before the show started recording about how medicine in the current landscape is failing people. It treats people like a set of boxes to check, like humans are a bag of organs. We cattle herd, we box check, we move people along the conveyor belt, when health to me, and I'm sure to your husband, who's also a doctor, is rooted in the relationship with a patient, is founded on trust. And particularly when we're talking about complex issues like substance use and overuse, it requires time to get to know the patient and then unlock those complicated stories.[00:02:25] So, this is why I'm thrilled to have you here because it's clear to me that this is not just your job, but this is who you are. So I'd love to talk first about your story and how you became interested in substance use.[00:02:39] Jessica: I couldn't avoid it because I was raised in a home with someone with substance use disorder. One of my parents and one of my parents was raised with a person with substance use disorder and so on and so on, and so on and so on. And when I first got sober, On June 7th, 2013. Not coincidentally, my mother's birthday, I got blackout drunk at her birthday party.[00:03:03] My very first thought was, okay, well hold on. If I'm part of this long legacy, and by the way, my husband is part of a very long legacy of substance use disorder, how on earth do I make this stop for my kids? I mean am I just, are they just destined to carry? And I had so many questions about genetics and risk factors and all that stuff.[00:03:27] And more than that, I had also been a teacher for 20 years. And after I got sober, I started teaching in an inpatient recovery center for adolescents. And I wanted to understand very specifically, how those kids ended up there, what could we could have done differently, both from a parenting, from a social, from an educational perspective, how those kids ended up there.[00:03:50] And then looking at my own kids, I got sober when they were nine and 14. And I really just needed some answers. And I was hearing, most of the information I had in my head was myth. It was magical thinking. It was myth, it was rumor. I needed to understand, if we give kids sips when they're younger, does that do anything about helping them learn moderation or should we be aspiring to be like those European families that we talk about so much?[00:04:19] And anyway, so all of that stuff, I needed answers. I have the coolest job in the world, which is to get curious about topics and then get paid to research the heck out of them, and then translate that research for people who don't wanna dive in and research for two years to get the answer to a topic.[00:04:36] So my job is not just… I'm a writer, but I'm at heart, a teacher. I mean, not just to kids, but now I get to go out into the world and translate all of this stuff. And if there's nothing I love more, it's helping people think about topics that freak them out. Whether that's letting your kids fail with Gift of Failure, whether that's substance use prevention stuff.[00:04:59] It's the reason that I've stuck with this substance use prevention stuff, because it's just so hard to get people over the shame, the guilt, the fear, the denial in order to talk about this stuff. So that's one reason that I make daily videos about this stuff. I'm out there speaking to lots and lots of people, and sometimes it's an uphill battle, but it's really, really fun.[00:05:23] Dr. McBride: I can tell you're enjoying it and you're so effective at communication. I'm the same way. I love complicated patients. I love the layered kind of kernels of people's interiority and how their thoughts, feelings, and behaviors are interrelated and then explaining it to people. I also love tackling topics that tend to freak people out, like death and dying, delivering bad news, like somehow that's like my Super Bowl. And I think one of the reasons is because, at least for me, I see the fear in people's eyes and I see the shame that they carry and then being able to kind of convey a message to people that is, that they can wrap their arms around is really gratifying. When it comes to substance use disorder, I think a lot of parents are freaked out.[00:06:12] I think they read the headlines. They see how pre pandemic, we had an epidemic of diseases of despair, including substance use disorder that is only accelerated during the pandemic and they don't know what to do. And they know their kids in their adolescent years are trying alcohol, drinking in kids' basements.[00:06:30] They're kind of looking at what other parents are doing and not knowing who to trust. And so I'd love to hear from you what are the common myths that parents tend to hold in their minds about substance use disorder in adolescence?[00:06:47] Jessica: Yeah, I think this is really important because it's also the myths that get translated to their children. And the big ones are things like, first of all it's a fait accompli—kids are going to drink anyway, so I might as well teach them how to do it responsibly, either because I have beer at my house and I take away everyone's keys, and at least they'll be safe.[00:07:06] That sort of just fatalistic, it's going to happen anyway because that's simply not true. The numbers are so much lower than people understand, and I get into that. In the book, there's this thing called pluralistic ignorance, which is we tend to overestimate in the case of alcohol, for example, how much people tend to drink, the people around us and how invested they are in having alcohol around.[00:07:28] And we all tend to overestimate that. So that sort of fatalistic thing, the whole, you know, I really want my kids to be like those European kids. So therefore if I let my kids have sips at home, let them have their own beer, a little bit of wine, that kind of thing, it'll somehow teach them to be moderate drinkers and not freak out when suddenly alcohol is available to them at college or whatever.[00:07:51] And that's wrong for so many reasons. I mean, the European Union as a whole, based on data from the World Health Organization and specifically World Health Organization Europe has the highest level of alcohol consumption in the entire world, and the highest level of deaths and illness attributable to alcohol.[00:08:10] Yes, there are exceptions, and that's a fantastic conversation to have as well, because that's about outliers based on the fact that those countries tend to have very particular community standards around public drunkenness. So the outliers tend to have to do with community pressures, and that leads to a great conversation of family culture, school culture, city culture, all those kinds of things.[00:08:33] And then, the idea that our kids don't listen to us because that's just not true. Even as kids get into college, they report that their parents tend to be their preferred and most trusted source of information for especially health, personal health, that kind of stuff, that kind of information. And finally, I want to also, I think it's really important to remember that substance use disorder and substance use are two different things. Lots of kids can try substances and not go on to have a problem with substances over the long run. And it's important to understand from an objective perspective what those risk factors are so that you can say, oh, my kids are at higher risk, or this puts my kid at higher risk, so what do I do specifically to deal with that. And then finally, I think it's also important to remember that yes, substance use disorder, we're having a crisis right now with mental health and stuff like that. And substance use disorder or substance use can be one way to cope with that. But prevention works. Effective prevention works.[00:09:31] And we're at, we've seen a 10 year decline really now 15 year decline in most aspects of substance use in adolescence. And that's because prevention works. And in order to do that really great prevention work, we have to be objective about risk factors, and we need to realize that adolescent brains are different from adult brains. I don't talk about adult substance use that often, except for when I talk about whether or not you should do it in front of your kids and what your messaging should be, because the adolescent brain is just different from the adult brain.[00:10:06] Dr. McBride: Okay. I wanna talk a lot about the adolescent brain, having three of them in my own house. I welcome your insights. Actually, two are in college, but they do inhabit my house every now and then. But let's go back to the first myth for a second. The myth that parents, I think, believe quite often, and I have believed in some ways, which is that it's inevitable they're going to use alcohol, trying to stop them from drinking alcohol or experimenting with it in high school is kind of like stopping a 747. I think a lot of parents think, as long as we've had the conversation, then this is, this is the best we can do. What data is out there, Jess, to show that delaying your exposure helps prevent the likelihood of substance use disorder?[00:10:56] Jessica: So first it's just important to remember that there are two periods of brain development that are the most important. They're just these massive periods of brain plasticity, and that's zero to two and puberty to around 25-ish, depending on the kid. So what we need to remember is that that development, that cognitive development that's going on, and that brain development that's going on from puberty to 25-ish, we don't fully understand all of it, it is massive. It's happening all over the brain. It's happening with lots of different centers. The executive function part of the brain, the upper brain is connecting to the lower brain, and anyway, that needs to happen as unimpeded as possible. What we do know is that the younger a kid is when they first initiate their substance use, the more likely they are to have substance use disorder during their lifetime.[00:11:46] So for example, if a kid starts in eighth grade, it approaches a 50% chance of developing substance use disorder over their lifetime. If they start in 10th grade, it goes down to around 20%, a little bit less than 20%. And if you can get them to 18, we get so darn close to 10%. It's important to delay, delay, delay. So that's one reason. Not only are we lowering their statistical risk of substance use disorder over their lifetime, and yes, there are some confounders in that data. There are confounders. I mean 90% of people who develop substance use as an adult report that they started before the age of 18.[00:12:26] And of course there are issues in there that we can't control for—the social determinants and all that kind of stuff. Families that have more alcohol around are gonna have kids that are more likely. So there's all of that as well. But this is what I'm dealing with in terms of the statistics.[00:12:42] Also remembering that the development, the longer a kid goes without ingesting anything that messes, whether it's with your dopamine cycle or fills up receptors in your brain that are, should otherwise have naturally occurring neurotransmitters in those receptors, because we're introducing them through drugs and alcohol. The brain just needs to develop as unimpeded as possible for as long as possible. So we're protecting their brains and we're lowering their risk of substance use disorder over their lifetime.[00:13:11] Dr. McBride: It makes sense in a lot of ways. The way I think about it is that the longer you give adolescent brains to ripen on the vine, and the longer you give kids who are dealing with a lot of complex thoughts, feelings and emotions and genetic predispositions, the more chance you give them to find and practice coping with hard thoughts and feelings. You just give them more opportunities to realize that they like drawing, they like being outside to play sports, they like laughing with their friends, they've realized who their intimate friendships are and where they can go to put a lot of thoughts and feelings instead of the default mode to alcohol, which for some kids, as we both know, is a occupational hazard for our kids who are in distress.[00:14:02] Jessica: And that's really apparent when you see what happens to a kid who has substance use disorder. They come to rehab. We remove the substance they're using as their coping mechanism. Suddenly you have kids with unresolved trauma. I mean so much. When we talk risk factors, you know, trauma is a big part of it.[00:14:21] So suddenly we have these kids that have been using this one and only coping mechanism for so long that they. Not only don't have coping mechanisms for that trauma, but they don't have coping mechanisms for interpersonal disputes, for just feeling anxious. All of their coping has been through using the substance instead of actually learning a real coping mechanism, which is why we often talk about kids in recovery as having been—in some ways not always—having had their development arrested at the age at which they started using the substance and. I don't agree with that fully, but what I do [00:15:00] know is that it does arrest their ability to learn prosocial behaviors, to learn coping mechanisms, to learn how to as we often hear from, for example, Dr. Dan Siegel, integrate their upper and lower brain, and figure out how to be slightly outside of their emotions as opposed to living completely inside of their emotion and reacting from their limbic system, from their lower brain and not engaging that upper sort of more rational part of their brain. Yeah, it's tough.[00:15:31] Dr. McBride: I just had Lisa Damour on my podcast.[00:15:33] Jessica: She's fantastic.[00:15:34] Dr. McBride: I love her too. And we talked, as you would imagine, about the rainbow of emotions that adolescents have and how complex they are and how they don't have necessarily in their teenage years, the vocabulary with which to discuss feelings. They don't have the interest always in talking about their feelings, and they don't even know they're having them sometimes.[00:15:55] I have this poster in my office. That's the periodic table of emotions. I have a version at home too. It's like the periodic table of the elements, but it's emotion. So instead of believing that we have happy, sad, mad, we have rage, we have jealousy, we have envy, we have fear, we have this whole rainbow.[00:16:19] So my kids tease me about it because they're like, oh my God, there's mom with the rainbow of emotions again. But then I see them when I'm not looking like my son and his girlfriend kind of being like, “hmm, I'm feeling kind of vulnerable today.” So what is my point? That it is a natural human instinct, whether you're a teenager or an adult who's experiencing complex emotions that are uncomfortable and maybe not even named to seek out places and ways to soothe, and I think adults do this. This is why I have a job. But teenagers, without the vocabulary, without the tools, without the insight that you are helping them grow and that I see older teenagers myself, it can be a very complex landscape and they're… Alcohol in our culture is socially acceptable and legal, and so it seems natural that they would experiment with it, and then you're off to the races.[00:17:11] If you have a kid who all of a sudden feels, wait a minute, my social anxiety has been quieted, my uncomfortable thought has been muted, my fear is less loud. And they don't even necessarily articulate it that way, but it makes so much sense that this is an occupational hazard of being an adolescent.[00:17:29] Jessica: Yeah, there's definitely a camp—in any field there are camps—these little camps of people who believe various things. And there's the trauma camp, that substance use disorder response to trauma. There's also the developmental camp, and I think that's really important. I think the reason that I and you and Lisa love adolescents so much is because, we tend to have a deeper understanding of how their brains work, which is why I tell parents that the more you understand about your adolescent's brain, the better you can be at stepping back and not just reacting to some of the buttons that are being pushed.[00:18:06] And I think that whenever I—in fact, I tell parents, whenever you're most frustrated with your teenagers, just look between their eyes at that spot, right between their eyes. And remember, that's the part of the brain that's not fully connected yet, and that what they're doing in terms of their adolescence is designed to make kids want to push out and to individuate, but also to try new things.[00:18:30] What's so cool about that? In trying new things in seeking out novelty and yes, sometimes novelty comes with risk. When they succeed at those things that they're trying out, when they build new skills, they're actually boosting their dopamine and boosting dopamine through… Kids are constantly craving dopamine. They want, we all want to feel good, we all want to have that feeling of mastery, inhalation, and all that sort of stuff. But if we want our kids to seek that out in healthy ways and healthy places, we can push them towards positive risk on to skill building and building competence, and then they can sort of get that dopamine cycle going in productive ways.[00:19:13] But I think the minute that you just sort of shut down and say teenagers are difficult, they're moody. I heard one time on a podcast on—it might have even been This American Life—it was definitely on NPR a long time ago when I was a middle school teacher, I heard a middle school teacher say, sometimes I let myself just think that we should send these kids away to some holding place until they're ready to listen and able to learn again.[00:19:43] And it makes me bananas because the exact opposite is true, that for people that really love and appreciate and understand adolescence and especially early adolescence, the more we understand what an incredible opportunity there is for learning, and how much learning is actually going on during that period, and enjoy it more, the more we understand it, the more we have the potential to enjoy it.[00:20:08] Dr. McBride: So talk to me about what do you see as a major differences between the adolescent brain and the fully formed adult brain as it pertains to substance use disorder and dopamine, et cetera.[00:20:21] Jessica: Yeah, so I rely heavily on the Dan Siegels and the Frances Jensens and the Laurence Steinberg's to help me see—as Laurence Steinberg refers to—adolescence as an age of opportunity. And I love that because so many other people are talking about this a terrible time, but what you have to understand about the adolescent brain, and varying people describe it in varying ways, but there's sort of a mismatch between the part of the brain, the early developing part of the brain, the lower brain, the reacting part of the brain that is just like, you know, go, go, go, emotions, emotions, emotions and the part of the brain that's still getting connected that handles executive function and prioritizing of resources and time and all that stuff. And that mismatch seems to persist until just about the time that we want to freak out and give up on them. And then suddenly, and it's so cool being a teacher because you get to bear witness to these moments, and eighth grade is a great time for this. [00:21:20] For example, I taught English, and so I taught a lot of literature that had metaphor and symbolism in it, and many middle school kids, not because they're dumb, not because they're smart, not because they're lacking anything, can't understand metaphor in a way that some, maybe some of their classmates can. But you don't stop talking about it just because they don't understand it yet. You just keep offering it. You just keep offering it in ways that are obvious so that the day that those neurons connect, you can see their eyes just go wide and they go, “oh. That's what she's been talking about.” And that same thing can happen with strategies for organization.[00:22:03] I talk in the Gift of Failure about when my daughter finally connected this strategy for helping her remember things and actually remembering things and being able to go to school with her stuff. And had we been arguing about it for months? Oh yeah, of course. But it wasn't until for whatever reason, those neurons finally, finally decided to connect.[00:22:26] And there have been times as a middle school advisor where, you know, I had a family once beg me to be their kid's middle school advisor, because I had been his brother's middle school advisor and his brother had made leaps and bounds during middle school. And I'm like, that's really sweet that you wanna attribute any of that to me and being his advisor. But it's just that his lower brain and his upper brain finally connected, and I was lucky enough to be there when it happened and capitalize on some of those moments. And that's what's amazing to know about the adolescent brain is that all of these things that we're being asked, we're asking them to do that they may not be ready for.[00:23:03] All of that creates stress, anxiety, a need for some kind of control over their world, and if we give them the autonomy and we give them the competence that they need, what ends up happening in their brain is they feel this, as I mentioned, the dopamine cycle lets them have this great burst of dopamine. If you wanna read more about that, please read Anna Lembke's Dopamine Nation.[00:23:26] It's such a fantastic book. And on the other side, the less kids get to feel that feeling of self-efficacy, of competence, of skill building, the more helpless they feel, the lower their feelings of self-efficacy become, and the more they turn to things other than their own abilities in order to help themselves cope. And it's the reason I quote Chris Herren. Chris Herren, former Boston Celtic, ended up addicted to opiates. It's a fantastic story. Basketball junkie, if you ever wanna read it. And he goes out and speaks to kids a lot and he, I quote him in the addiction inoculation as talking about the fact that we tend to spend so much time talking about the last day of substance use.[00:24:07] How far we fell, how disgusting it was on my mom's birthday on June 7th, 2013, and how ugly it got. But what we need to be talking about, especially when it comes to kids, is the first day, and he talks about that moment when a kid is at a party in a friend's basement, and why they don't feel like they are enough. They deserve to be loved. They don't deserve to take up space. They don't deserve to be here. What is it that makes them turn to substances? And I'm really lucky in that I get to talk to a lot of kids and hear what those moments sound like for them. And we need to help them feel like they're enough in those moments so they don't have to turn to something else.[00:24:49] Dr. McBride: I wanna break that down and I first wanna just comment that. You know, I think a lot of substance abuse programs in schools focus on this on the last day, right? Like, they focus, they, they bring people in and try to scare the pants off of kids. They show images of drunk driving accidents and kids are supposed to go away thinking, “oh, I don't wanna be in a car accident. I don't wanna die.” But in my experience with teenagers, myself, as a physician and as a mother, that doesn't really work. And then we know the data are clear that scaring people doesn't work. We have to meet people where they are. And it's clear that, as you talk about so beautifully, the roots of a healthy program to educate kids and on substance use is social emotional learning. So can you talk a bit about that and how that relates to the prevention as individual parents who may be listening?[00:25:45] Jessica: Yeah, so backing up, for example, in this country, only 57% of high schools in this country, and by the way, high school is too late to be starting this. Anyway, we need to be starting these programs very, very young, and I talk about that in Addiction Inoculation. Only 57% of high schools in this country have any substance use prevention program.[00:26:02] And of that 57%, only 10% are based on evidence. On any kind of evidence of efficacy, that kind of stuff. So what we know about the best available substance use prevention programs is that they start very young, pre-k, k, and continue all the way through the end of high school. They are rooted in social emotional learning, refusal skills, building self-efficacy and self-advocacy, and essentially giving kids from a very early age, pro-social skills and coping skills, coping mechanisms.[00:26:37] It's the reason that some have mindfulness programs attached to them and unfortunately, we're in this horrible position right now where we know these programs work. Oh, and also life skills, by the way. Life skills are a very important part of these programs as well. We know that social-emotional programs that contain health modules—making sure your bodily autonomy and safety and self-advocacy and stuff like that. We know those work. And yet, right now, For the first time ever, social-emotional learning is under attack because there's a faction of society that sees social-emotional learning as something that it's absolutely not, which is either indoctrination or identity and whatever. And it's really, really upsetting to me because without social emotional learning programs, which are just about building pro-social skills and skills that help us be a part of society and get along with other people and advocate for ourselves and all of this stuff that we know is so important.[00:27:36] Ask kindergarten teachers, they repeatedly say those are the skills that if you were to look at kids and say, okay, that kid is probably gonna do really well, and that kid probably is not. It all comes down to pro-social skills and behaviors. If we do away with social emotional learning, there have been places I have spoken where I've been asked not to use that acronym because it's quote “problematic.” This is a disaster because this is what we know works for substance use prevention programs, and we abolish that at our peril. Any gains we've made in the reduction in substance use among adolescents, we're going to lose.[00:28:15] Dr. McBride: I could not agree with you more. I mean, social emotional learning to me is about giving yourself permission to be human, to be flawed, and to have bodily autonomy, and as you said, the refusal skills and the ability to learn how to cope and function in the real world. [00:28:34] Jessica: Self-regulation, collaboration. Well, and then if you look at risk factors for substance use disorder, we know that 50 to 60% of the risk lies in genetics. That's Dr. Mark Shook at the University of California, San Diego. We know that the other 40 to 50% is adverse childhood experiences, trauma, stuff like that, and then set.[00:28:53] And of course, the social emotional learning stuff can help kids with that. But then on the other hand, we also know that child on child aggression, academic failure, social ostracism, undiagnosed learning issues, all of these other things are risk factors as well. And if social emotional learning programs help with so many of the things that can counteract social ostracism and help identify academic failure early on and can help reduce aggression between children. This is such an important part of the substance use prevention picture, and because we also know that self-efficacy is one of the most important things we can give kids and self-efficacy comes from the ability to self-advocate and self-regulate. It's all this self-perpetuating cycle that if we throw a wrench in there, sorry to mix metaphors, that we, this whole thing grinds to a halt and we have a whole bunch of kids who not only can't get along with other people, but don't have any coping mechanisms within themselves to manage their own stress. All that stuff Lisa Damur talks about with girls and Yeah.[00:29:58] Dr. McBride: When I was growing up, it was just say no. That was the mantra.[00:30:01] Jessica: And we know that doesn't work[00:30:02] Dr. McBride: and it would be really easy to say no if you had the social wherewithal, the confidence, the emotional skillset to manage that moment when a kid asks you if you want a beer and you're an eighth grader…[00:30:14] Jessica: Well, and that's not even enough. That's not even enough. So what we need are, they're ultimately called refusal skills. I sometimes call them refusal skills. I call them in Addiction Inoculation—the inoculation. There's a school of sociology called Inoculation Theory. It's essentially if we give kids the information they need in order to counteract messaging that's coming from other places, whether that's from liquor companies advertising beer to kids during sports, or another kid in their class. So let's say for example, you have an eighth grader who gets offered a beer. And the rejoinder to “no thanks” is, “come on. It's no big deal. Everybody's doing it.” If your eighth grader knows, well, it is kind of a big deal because here's what's happening in my brain and, and blah, blah, blah, and they know that it's not true that everybody's doing it. That in eighth grade, by the end of eighth grade, only 24.7% of eighth graders admit to having had more than a sip of alcohol.[00:31:16] So if they have that information, it makes them feel more confident in their stance and makes them more likely to continue to stick with their rejoinder of, “no thanks. I'm good.” And that those refusal skills, that inoculation messaging is so important and we have to start that early and continue it through.[00:31:37] So it's not just about the wherewithal, the emotional wherewithal to say, no, we need to give them the actual information to back that up so that they can feel more confident in their stance and they can have a reasoning behind their stance. And it's the reason, by the way, that of the entire book. There's a lot of things I loved about writing this book, but my favorite part, I didn't necessarily write. I asked adolescents to give me excuses they could use in public at a party or whatever that would help them save face and yet allow them to get out of using if they didn't want to. And there's two and a half pages of those in the book, and I'm so grateful to all of the kids that sent those to me because so many of them are brilliant and I wouldn't have come up with them on my own.[00:32:21] Dr. McBride: Give me some examples. I'd love to hear, and for any parent who's listening, I would love to like have you flip to that page because if we can arm our kids with like just the words to use and ideas, then that would be great.[00:32:36] Jessica: they are things like, “I can't, I get migraines” because we know that, for example, wine, alcohol is a trigger for migraines. “I can't, I have a sleep disorder.” We also know that alcohol is a major component of sleep disorders—it exacerbates sleep disorders. “I can't. I'm taking an antibiotic.” “I can't. My parents drug test me. Aren't they horrible?!” or “I can't, my mom breathalyzes me when I get home.” or even just in their own head. My son, who's now 24, when he was in high school, he admitted to me that while he doesn't say this out loud in his own brain, he's like, “I know that I'm at increased risk for substance use disorder, and my mom had to work so hard to get away from the pit of despair that she reached in her alcoholism. I think I'm just gonna not risk that for now,” or “I have an early practice. I can't.” “I'm the designated driver,” which by the way, makes you more popular with other people because you can help them get home safely and not get in trouble and not get pulled over. There's all kinds of things that we don't even think about.[00:33:42] A lot of Asians have something that's like a flushing disorder that is actually, it's sort of a… it's not really an allergy to alcohol, but it is something that makes drinking alcohol quite unpleasant. So you can go with that. There are a few studies, there's all kinds of ways that you can get at this.[00:33:59] It's just not the best thing for me right now. And I think the big overlooked answer is, “nah, that's okay. I'm good.” No is always an acceptable answer. And even in in sobriety, I have to value my sobriety and my safety more than maybe the worrying about upsetting my host, if I need to go home early from a dinner party where I'm just not feeling safe anymore and my husband and I have a signal and we've got all kinds of exit strategies and stuff like that, but helping kids know that they're worth it, that they are allowed to say no and that, obviously we have to make sure they know that in terms of unwanted touching and having sex before they're ready, all of that kind of stuff, we have to sort of empower them, give them the self-efficacy they need in order to feel like they're entitled to say no to whatever the heck they want to if it feels like it's going to endanger their safety.[00:34:56] Dr. McBride: And I do think kids these days are feeling more empowered to say how they feel to put limits down, to set boundaries. But of course, without the vocabulary and tools and the social support and the emotional vocabulary, it can be more difficult.[00:35:11] Jessica: Yeah. And that why that's part of the dovetail also with Gift of Failure, is that we know that parents who are highly controlling of their children tend to have kids that lie to them more often, and also that don't feel heard because if you are from that school of thought of do it because I said so or because I'm the parent without attaching any of the why to it, then it's like the difference between saying, I would prefer that you not drink until 21 because it's the law versus I would prefer that you not drink until you're 21 because of the potential damage it can do to your brain and because it can raise your risk of, of substance use disorder over your lifetime.[00:35:48] I'm a why kind of person. I need to know the why. Otherwise, I am not invested as a learner and many kids are the same way. Just telling them, because I said so doesn't tend to be a winning strategy.[00:36:02] Dr. McBride: To what extent are parents, quote unquote, “responsible” for their kids' relationship with alcohol? I'd love to talk to you about genetics versus experiences. The whole trauma argument that…I'm sure you know Gabor Mate and his system, I mean, he's wonderful. I also take a little bit of an issue with the idea that it's all rooted in trauma. I also believe on the other side that trauma is a, is a big word and can mean lots of different things. Feeling unloved and unsafe in your home for whatever reason can be traumatic. It's not just the. Experience of say, you know, breaking your leg and being ambulanced to the hospital. It can be an uncomfortable experience.[00:36:54] It's the way that experience is handled from the individual standpoint, and that can then lead to a predisposition towards unhealthy coping strategies. So talk to me about what parents are responsible for. How much is genetic and how much is environmental, because I don't think we know the answer, but I'd love your thoughts.[00:37:17] Jessica: Yeah, so like I said, the, the figure we have on the genetics is about 50 to 60%, but then you add on top of that this added layer called epigenetics, which is a crossover between environment and genetics. Also it's not just one gene. We're not gonna ever have this CRISPR technology where we're like, oh, we can flick that one gene out. Look. And addiction is gone. It's not like that. It's tied into personality, it's tied into chemistry. It's tied into so many different aspects of our environment. And again, epigenetics determines how genes either do turn on or don't turn on, that kind of thing. So then on top of that,  the other 40 to 50% is yes trauma.[00:37:56] Jessica: But there's all different kinds of trauma. If you read Lisa Damour's Under Pressure, you understand the difference between stress, like there's little T trauma and there's Big T trauma. I think everyone on the planet should have to read Nadine Burke Harris's The Deepest Well, because average childhood experiences as originally defined by the CDC and Kaiser Permanente are really valuable, right?[00:38:21] Because we know that people who have. People are more likely to have negative life outcomes in terms of health, mental health, all kinds of other stuff. If they've had various adverse childhood experiences and there's a really handy list, go google Adverse Childhood Experience and Quiz, and you can take the quiz yourself.[00:38:38] However, it is not a complete list. The things that are on that quiz are a great starting place. For example, we know that physical and especially sexual abuse is a huge, huge glaring blinking neon sign risk for eventual substance use disorder. That's a huge, massive risk. So the adverse childhood experiences list of 10 things within categories comes close, but then there's also… it doesn't take into account Nadine Burke Harris's list, which can include things like systemic racism. Why on earth are we not counting that as a big T trauma because it absolutely is. There's a lot of debate right now around adoption, around all kinds of things that qualify as—can qualify as traumatic experiences for kids.[00:39:24] So, and you should know about me that anytime someone says it is, All this or all that, I'm immediately suspicious as a journalist[00:39:35] Dr. McBride: Well, I'm the same way. I mean, that's, that's it. I mean, everything is in the middle. It's not all nature. It's not all nurture. It's in the middle.[00:39:40] Jessica: Well, and that's why, you know, there's an entire chapter essentially. What if I were to write about the peers chapter, you know, why did I include a chapter on the influence of peers in the book?[00:39:49] Why bother? Because I could have just said, research shows that the more your kid's friends use drugs and alcohol, the more likely your kid is to use drugs and alcohol. Okay? Chapter over. But the problem is, it is a much more nuanced picture than that. And I tell the story in that chapter of. My son Ben had a friend who, Brian, that's his real name.[00:40:08] He was insistent—the two young adults I profile in the book, Brian, and Georgia insisted that I use their real names because they felt this was just too important. Brian and Ben became friends. Brian had been already kicked out of one high school, then got kicked outta my son's high school for substance use and behavioral stuff and my, my kids stuck by him and all their friends stuck by him and I'm like, look, my instinct as a parent is you cannot be friends with this kid because if he does substances, you are more likely to do substances. In the end, that relationship was much more complicated and the fact that my son, Ben, and his friends stuck by Brian actually led to the moment where Brian realized on the second time he got kicked out of that high school and my son and his friends took him running on the last day, he was allowed to be on campus. Brian realized in that moment that was his turning point. That was his 100th piece of his puzzle where he said, it all has clicked into place and I see what I stand to lose, and my son benefited from the object lesson. The real scared, straight sort of object lesson, real life learned experience of, oh, this is what happens when you rely on substances in order to manage these other things. [00:41:26] And here let's talk about those things. And PS the best part of that whole relationship was I said to my son, “Ben, look. I'm so pleased you want to support him and go visit him in rehab and all that stuff. Loyalty is great and a friendship, but if you're going to be friends with Ben, knowing what I know about the statistics, we're gonna have to talk about this a lot.”[00:41:47] And that was something that became a standard conversation topic for us. How's Brian doing? How are you doing about Brian's… how do you think Brian's doing? How do you think…what are you seeing that works for Brian and what doesn't work for Brian? It gave us a proxy so that my son didn't have to talk about himself as much, which can be very difficult for teenagers. But it allowed us this proxy to talk about substance use and substance use disorder in the guise of Brian and gave Brian a launching off place for his, what became his recovery.[00:42:19] Dr. McBride: It's so lovely and I really like the way you talk about Georgia and Brian in your videos and in your book, because it just helps parents, I think, hook into the realities of these kids' lives with empathy and compassion for their stories and great respect for their privacy. Obviously, that the fact that they wanted to share their stories means that they feel that this needs to be talked about more than it is.[00:42:45] Jessica: Yeah, I can't count the number of times. I was like, no, really, let's do a pseudonym. You can choose the pseudonym. And even recently with Brian, I had to get in touch with Brian about something and I wanted to make sure that they were making that decision from a place—and they were [00:43:00] adults when they made this decision—but that they were truly making this decision from the perspective of, you know, I appreciate that. A lot of people have shame and guilt in that. There may be some persecution that I could face maybe in the workplace later if this got out, that this was me, but this is too important. It has brought some value out of everything I went through as a kid, as a child of an alcoholic, everything I went through as an alcoholic.[00:43:25] And this education might help someone else. And I think that's really where Brian and Georgia are coming from, from this. And I talked to Georgia last week, talked to Brian two weeks ago, and yeah, they're doing great. They're doing so well.[00:43:39] Dr. McBride: It's incredible. I'd love to now segue into talking more about you if I could because you are talking the talk and walking the walk. So had you tried to get sober in your life before that moment at your mother's birthday party?[00:43:56] Jessica: I've had periods of sobriety because I was scared. Like, you know, I did that, I did that thing a lot of sober curious people do, and to make it clear, I'm so hopeful about where we are right now because I think a lot of people are realizing you don't have to rise to the level of completely out of control, homeless, DUI, all that stuff, getting fired from work. You can say to yourself, “man, I'm gonna try dry January and just see how it goes.” And then you realize, oh wow, this kind of feels better. And so I'm gonna keep going. You can stop drinking just because it's not working for you anyway. I was scared to death.[00:44:30] I tried through the guise of long distance running like I used, running as a reason to stay sober, to not drink, and I would make all kinds of bargains with myself. When I was pregnant, I was sober. When I was training for big races, I was sober, but it just was starting to take over to a degree that I couldn't control it anymore on my own. And so the reason I talk about getting to a place where I know I needed help as a 100 piece puzzle is, you know, my dad on that morning, after my mom's birthday party was my 100th piece. But pieces one through 99 had to be there for all of that to click into place and form a big picture.[00:45:13] And those early attempts at sobriety were pieces of that. And the beauty of all of this puzzle piece stuff is that I can't guarantee that my kids are not gonna develop substance use disorder, but all of this prevention stuff are pieces of that puzzle. So maybe they get to start at piece 65, where I started at piece 32.[00:45:34] It builds those blocks. So I was able to get sober. I happened to get sober in 12 step and. There are lots of ways to get and stay sober. I happen to get sober in 12 Step, and my higher power is the people in those rooms and the people I work with at the rehab where I work now. I work as a prevention coach and sort of a recovery resource at Santa at Stowe.[00:45:58] It's a recovery in Stowe, Vermont. It's medical detox and recovery, and they are my higher power. I can't show up for them. Unless I'm sober, I can't go do my speaking engagements. I can't do my daily videos unless I show up sober because then I'm being completely inauthentic and I would be hungover and miserable.[00:46:18] But all of my stuff has been partially in service to getting control of my life back and being the parent that I know I need to be in order to raise two kids who might break the cycle of this. [00:46:36] Dr. McBride: What I'm hearing from you is that. Your sobriety is rooted in the 12 steps. It's also rooted in the ongoing process of helping other people, which is one of the tenets of AA is passing on your knowledge and wisdom to other people and, and making meaning out of an experience, and I think you really are making a difference.[00:46:55] I see people reading your book. I hear p people reading your book. I've had my kids listen to your videos, and not that they necessarily wanted to, but I have heard some good feedback because I think what happens when we talk about alcohol to adolescents is it often comes across as a parent as just a, a moralistic, judgmental, do as I say, conversation[00:47:22] Jessica: And not necessarily do as I do, because if…[00:47:25] Dr. McBride: not necessarily right. And then we go, poor gin and tonic. And they're like, Hmm. It's funny, one of my most popular posts on substack, like by a mile was the post I wrote called “Is Dry January a good idea? And I put it out on January one.[00:47:40] And I mean, the answer to the question in my mind was probably what you wouldn't be surprised to hear, which is that sure. It's only though scratching the surface of the curiosity and compassion and empathy we need to have about ourselves and about the why, because you can put a fence around a behavior for 30 days, 31, I guess, in January, and then on February 1 you can go to the pub and get plastered or just start drinking again.[00:48:07] The question isn't, can you give it up because you can…[00:48:10] Jessica: I gave it up for a year.[00:48:12] Dr. McBride: And for some people that's very hard, but the harder question is mining that interior landscape that is driving you to drink when you don't want to, if you're remorseful the next day, [and] you wish you hadn't done it. That is hard work, and it's much easier to put a fence around it for 31 days. I'm not saying don't do it. I'm saying do it and get curious.[00:48:34] Jessica: One of my favorite speaking gigs is, and don't hate me for this, but every six months or so I'm at Canyon Ranch, either in Tucson or Lennox, Massachusetts, and they put me up and give me a discount on spa stuff for me and my plus one, and I do my talks. But the cool thing about Canyon Ranch is that there's no alcohol served there.[00:48:55] And some people bring their own because they just can't be without it for a couple days. But there are plenty of people who go there and realize that they hadn't anticipated how difficult it was going to be for them to not have it there as an option. And, and then every—because Canyon Ranch was founded by someone for whom recovery is part of their story—there is a meeting there every single day at five and the people that often, and I often run those meetings and the people that show up at those meetings are often people who are like, “I don't really know why I'm here. All I know is it really bums me out that there's no alcohol here and I don't know what that's about.”[00:49:29] So, you know, it's a[00:49:31] Dr. McBride: great starting point.[00:49:32] Jessica: Well, and also a lot of people are there either by themselves or with a spouse and don't know anyone else there. So they feel like it's a super safe place to go to a first meeting anyway. Either way, it's a really cool place to get to do the kind of stuff that I do. Because it's opening the door for them in a way that maybe they hadn't anticipated.[00:49:51] Dr. McBride: Yeah, I mean it's self-discovery. I think about health as not an outcome, but a process of laddering up from self-awareness to acceptance to agency. I mean, the serenity prayer… I'm not in recovery, but people ask me if I am all the time. I mean from alcohol, I'm, I'm in recovery from other s**t that I do, but because I really understand and believe in the concept of the Serenity Prayer, which is accepting the things we cannot control, which is a lot, knowing ideally what we can control, and then understanding the difference and not spending so much time over here and shifting our energy and attention and curiosity to this spot.[00:50:31] Jessica: You want to hear something ridiculous? This is so interesting. So two things. When the book first came out, it was first getting its reviews and stuff like that. I got one review where it said very specifically that I parroted AA stuff. So first of all, I did not use anything AA in the entire book except in one spot.[00:50:52] I said, this is where something, for example, like the Serenity Prayer has been useful for me, and this is the restraints that we're dealing with when we talk about this stuff. Like that's why don't talk about AA because it is, the minute I refer to that, that is the only thing someone will hear. And then I'm just stuck.[00:51:11] Dr. McBride: And they associate it with, oh, AA that's like my crazy Uncle Sal. I just drink a gin and tonic every night. What's it to you? So I think that your approach that is honest, empathetic, rooted in data, and that stems from your own experience of being perfectly imperfect is really valuable. And so I just want to say thank you for being here and thank you for doing what you're doing and God speed.[00:51:38] Jessica: I am so grateful to you for just having this conversation. Every single time I have this conversation with someone, I get an email or a DM from someone saying, you know what? I'm scared too, and I don't know what to do. Or, I'm scared for my friend and I need to know how to help them. And so, you know, the more we talk about this, the more other people are gonna feel like they're allowed to talk about it too.[00:52:02] Dr. McBride: Thank you all for listening to Beyond the Prescription. Please don't forget to subscribe, like, download and share the show on Apple Podcasts, Spotify, or wherever you catch your podcasts. I'd be thrilled if you like this episode to rate and review it. And if you have a comment or question, please drop us a line at info@lucymcbride.com. [00:52:24] The views expressed on this show are entirely my own and do not constitute medical advice for an individual. That should be obtained from your personal physician. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

This is the WFHB Local News for Monday, June 12th, 2023. In today's feature report, Dave Askins of the B-Square Bulletin provides updates on the city's plans to relocate Bloomington police headquarters to the Showers building and the redevelopment of the Hopewell neighborhood. More in today's feature report. That's Dr. Gloria Howell from the local …

When people ask who has the greatest experience with working with the people on a low carb diet, there is only one answer. That's Dr. Eric Westman. He was only person to actually conduct studies on the approach and methods that Dr. Robert Atkins employed to treat people with a low carb diet...that resulted incredibly reproducible outcomes. At a time when dietary recommendations by physicians was low fat Dr. Westman was looking in the opposite direct to change peoples health status.  —————————COME SAY HI!!! —————————— Facebook Group about Keto: https://www.facebook.com/groups/ketonaturopath/ ----------OUR NEW MEMBERSHIP GROUP FOR EVERYTHING KETO ---------Labs, Research and cooking, Implementation www.ketonaturopathmembers.com Weekly Live Zoom Q&A Sessions and private FB group BLOG: https://ketonaturopath.com/ Pinterest: https://www.pinterest.com/ketonaturopath YYouTube channel www.youtube.com/ketonaturopath Podcast: https://www.buzzsprout.com/482971/episodes Our Youtube Podcasts https://studio.youtube.com/channel/UC6LBX8_RDaXtzF_Z02jvl0QJudi's NEW cooking channel Keto Naturopath Kitchen https://www.youtube.com/c/KetoNaturopathKitchen ——————————— OUR COURSE —————————— PSMF 30 day course: https://www.thebiointegrationcode.com/courses/PSMFChallenge ———————— WHERE WE GET OUR WINE (an affiliate link) —————————— Dry farm wines www.dryfarmwines.com/ketonaturopath —————WHERE WE GET OUR Uric ACID FORA 6 METER ———————— https://www.fora-shop.com/ (that measures Glucose, Ketones, and Cholesterol together with Uric Acid) Get a 10% discount with this Discount Code: Ketonaturopath10 How we use the Fora 6 Meter https://youtu.be/0V5B_SXR6qM ————WHERE WE GET OUR GENOME SNP ANALYSIS DONE——————————— Strategene https://bit.ly/3iqCfka ——————————WHERE WE GET YOUR LABS DONE—————————————— https://www.UltaLabTests.com/ketonaturopath ————————— WHERE WE BUY OUR SUPPLEMENTS ———————————— https://us.fullscript.com/welcome/drgoldkamp/signupWhy get a Fullscript account to get your supplements?? 1. They have more brands than anywhere else to choose from; 2. Their prices are 20 -50% lower than anywhere else; compare and you'll see 3. This is where most physicians have their account 4. Been in existence for nearly 30 years working with physicians and health practitioners And make sure you subscribe to my channel! CONTACT: Questions, INQUIRIES: Karl: drgoldkamp@ketonaturopath.com Judi: support@ketonaturopath.com Sharing the metabolic strategy we used to regain our health and discoveries that will help you reclaim your vigor, and physique faster than you thought possible! No tricks, No marketing malarky, just the honest opinion of our own experience, 16 years of clinical medical practice, and having to save our own lives. 

May 15th, 2023. It's Monday! That means that we're back in the studio! Today we talked about a Florida teacher that showed an interesting movie to her students, Joe Biden giving the commencement speech at an HBCU, a hotel canceling a wedding party's block of rooms to make room for illegal immigrants, and so much more!

It is an honour to have the world famous cardiologist Dr Peter McCullough join us on Hearts of Oak again. We are getting a taster of the political shockwaves that are coming down the line with presidential candidate Vivek Ramaswamy recently saying that the public were duped on the COVID Jab and of course we have RFK Jr actively red-pilling the left. And just in the last week we have seen another slew of data on vaccine harms and excess deaths. The truth will be told and Dr McCullough is leading the vanguard as one of the main catalysts of getting this information out to the public. Dr. Peter McCullough is an internist, cardiologist, epidemiologist, managing the cardiovascular complications of both the viral infection and the injuries developing after the COVID-19 vaccine in Dallas, TX, USA. Since the outset of the pandemic, Dr. McCullough has been a leader in the medical response to the COVID-19 disaster and has published “Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection,” the first synthesis of sequenced multidrug treatment of ambulatory patients infected with SARS-CoV-2 in the American Journal of Medicine and subsequently updated in Reviews in Cardiovascular Medicine. McCullough has 51 peer-reviewed publications on the infection and has commented extensively on the medical response to the COVID-19 crisis in The Hill, America Out Loud, and on FOX NEWS Channel. On November 19, 2020, Dr. McCullough testified in the US Senate Committee on Homeland Security and Governmental Affairs and throughout 2021 in the Texas Senate Committee on Health and Human Services, Colorado General Assembly, New Hampshire Senate, and South Carolina Senate concerning many aspects of the pandemic response. Dr. McCullough has two years of dedicated academic and clinical efforts in combating the SARS-CoV-2 virus. In doing so, he has reviewed thousands of reports, participated in scientific congresses, group discussions, press releases, and been considered among the world's experts on COVID-19. Dr. McCullough is also known for his iconic views on the state of medical truth in America and around the globe. He pierces through the thin veil of mainstream media stories that skirt the major issues and provide no tractable basis for durable insight. McCullough aims to bring critical information and insights to the viewers and listeners in a concise and understandable format. Sit back, take notes if you are so inclined, and you will always come away better informed and more settled in your direction forward regarding personal and family medical navigation, home and health products, diagnostic tests, pharmaceuticals, medical devices, and the path forward for you and your loved ones. 'The Courage to Face Covid 19' in hardback or paperback.... https://couragetofacecovid.com/products/the-courage-to-face-covid-19?variant=41888573685916 Follow and support Dr. McCullough at the links below Website: https://www.petermcculloughmd.com/ Substack: https://petermcculloughmd.substack.com/?utm_source=substack&utm_medium=email GETTR: https://gettr.com/user/p_mcculloughmd Twitter: https://twitter.com/P_McCulloughMD Truth: https://truthsocial.com/@petermcculloughmd Telegram: https://t.me/C19ExpertChannel America Out Loud: https://www.americaoutloud.com/the-mccullough-report/ Concerned Doctors: https://concerneddoctors.org/dr-peter-mccullough-videos/ Interview recorded 11.5.23 *Special thanks to Bosch Fawstin for recording our intro/outro on this podcast. Check out his art https://theboschfawstinstore.blogspot.com/ and follow him on GETTR https://gettr.com/user/BoschFawstin and Twitter https://twitter.com/TheBoschFawstin?s=20  To sign up for our weekly email, find our social media, podcasts, video, livestreaming platforms and more... https://heartsofoak.org/connect/ Please subscribe, like and share! Transcript (Hearts of Oak) Hello, Hearts of Oak, and welcome to another interview coming up in a moment with Dr. Peter McCullough. He re-joined us, having been with us last year, and we start on the political side. I saw him at CPAC, and Vivek Ramaswamy, who is a US presidential candidate for the Republicans, said on a talk show he was duped, and the American people were duped, on COVID vaccines. He said if he was doing it again, he would do it differently. Wow. So I asked Dr. McCullough his thoughts on that, And then on his thoughts on Robert Kennedy Jr. standing for the Democrats and how that will blow up in the conversation on the left. Then we're going to just a number of reports and studies that have come out. Trida vaccine injury syndromes converges on victims and Dr. McCullough said this is what he's seen more and more regularly. This is the usual syndrome that he is seeing. And long COVID, being vaxxed. So it seems as though there's a correlation with that, talking about mRNA in breast milk and the impact this has on pregnant women and their unborn children. Then the reactivation of funding, federal funding for the Eco Health Alliance, unbelievable, but it is true. Even though they've been discredited, they've now been handed half a million dollars for funding. And then myocarditis, not recovering 80% of six months after vaccination, only 20% of young people are recovering within six months from myocarditis. And Dr. McCullough writes this in his sub stack that you need to go to and delve into this and understand this more deeply. And then we end up with excess deaths. Huge range of topics. And as always, Dr. McCullough brings his expert analysis to all of them. And hello, Hearts of Oak. It is wonderful to have back with us once again, the world-renowned cardiologist and chief scientific officer of The Wellness Company. That's Dr. Peter McCullough. Dr. McCullough, thank you for your time today. (Dr Peter McCullough) Thanks for having me. Not at all. And I understand that you are one of the most published cardiologists ever in America. I think it was a thousand publications and 660 citations. So you bring a wealth of understanding and knowledge and background to this. So I appreciate your time today. Thank you. You know, people have always asked, what do all those citations mean? You know, as a general rule in the National Library of Medicine, about 25 citations would qualify somebody to be a professor of medicine. And those who really race up in terms of their academic contributions, it just means they've looked at more data. There's been more scholarship. I focused on heart and kidney disease at interaction, made key discoveries, led key innovative groups, you know, in many areas of medicine. I've led data safety monitoring boards for important drugs, devices, strategies, presented at the European Medicine Agencies, the National Institutes of Health, New York Academy of Sciences. So I was well known in medicine before COVID-19. Now, since the pandemic, I've directed my scholarship entirely to the, pandemic response, have over 60 peer-reviewed publications in this area, including the seminal papers describing the methods of treating COVID-19 to reduce hospitalization and death. Wow, well I want to delve into the medical side but as I saw you at, as I said before, saw you whenever I was over at CPAC and you were always in many interviews being mobbed, but, if I could ask you some, two political thoughts I had. I saw that Vivek Ramaswamy, who's a candidate for presidential candidate, standing for the Republican side. I think a few days ago, he had said, I think it was the Steve Deace show, that he well, he had had two doses of the jab, but he said that he was duped. And I thought that was quite key. And then he went on to say if he was if he were to do it again, he wouldn't have done it the same way. But that for him to say he was duped, what were your thoughts whenever you heard a presidential candidate saying something like that. You know, we've been looking for some signals from the presidential candidates regarding the vaccines. The COVID-19 vaccine debacle is one of the biggest issues on the minds of Americans, and many of the candidates have been skirting around it. They just haven't addressed where they stood. And congratulations to Steve Deace, a friend of mine who, you know, Ramaswamy is a young man. He doesn't have considerable experience. You know, many think that young candidates, they're largely angling from some experience and maybe a cabinet position. But it was nice when Deace asked him directly about it, where he said he took the two shots, he regretted it. He felt America was duped. That means to be fooled or deceived by the government narrative. Said he would have done things differently. And so he left it open. I think that's journalists like yourself and others will have to ask him, well, what would he have done differently there? A young man like him who's thin and fit, there's no theoretical benefit of the vaccines, just the real harms, the real hard data on fatal and non-fatal vaccine injury syndrome. So he probably felt like he, later on, realized he took a personal risk with his health and regrets it. Now, that's on the Republican side and I'm curious and intrigued to see how that's brought into the debate. But on the Democrat side, you have Robert Kennedy Jr. And whenever he announced he was running, I was fascinated because he would be on the opposite political side as me. But actually, during the last three years, you rub shoulders with people you wouldn't normally. And he has been extremely vocal throughout his whole life on vaccines. And what were your thoughts on that? Because I think that could just blow the whole discussion, because again, you're thinking to the Democrat side, this conversation maybe hasn't been had as fully as maybe on the right. And him stepping into that, to me that changes the whole conversation. It certainly does. Robert F. Kennedy Jr., who's the son of the late Bobby Kennedy, our former attorney general, and the nephew of John F. Kennedy, certainly comes from a storied, family history of politics. He's a lifelong Democrat. He's not anti-vaccine. I know him very well. He's simply pushing for safe and effective vaccines. He doesn't want to see any more Americans harmed by vaccine side effects. The benefits of any vaccine are not, compelling enough to have harm done to the population. And we know since 1986, all the vaccine manufacturers have liability protection. So that isn't fair when someone is paralyzed or has a terrible side effect from a vaccine. And I think pretty clearly he believes no one should, receive any pressure, coercion, or threat of reprisal for vaccines. It shouldn't be mandated for school or for employment or military service. And we should have, all the states in the country should have full tripartite vaccine exemptions, meaning philosophical exemption, don't feel like you don't need to take it on philosophical grounds, religious and medical. So there should be freedom. He's pushing for freedom. This is very important. Medical freedom is related to social and economic freedoms. They're all related. And that's what I told America when I gave my Lincoln Memorial address. You know, that was a few minutes before Kennedy was up on the steps of the Lincoln Memorial with me. So I think we're very well aligned on this. You know, what I find interesting is that the COVID Community States Program weighed in from North-eastern University and Harvard, and a huge sample. So they actually figured out who took the vaccine. And the answer is in America, 25% of adult Americans, like me, did not take the vaccine. I didn't take the COVID vaccine. Best decision I ever made. I feel great. I don't have to worry about blood clots or heart damage or any of these lingering effects that we're seeing now. So many people who skipped the vaccine are so grateful they made the right choice. So that 25%, many of them actually suffered reprisal for doing this. They lost their jobs, family strife. There was a lot of unnecessary consequences that happened to people who made the right decision. Now, We only have 60% of the adult Americans who vote, only 60% vote. The 25% who didn't take the vaccine like me are likely to vote. So now we have nearly half of the voting block for the presidency where the vaccine is the issue. And everybody wants to know where do the candidates stand on the failed COVID-19 vaccines. That uptick really intrigued me and it's something that's come out in the UK that we now have a database you can put in your zip code for you over there or postcode and you can find out supposedly the uptake and one of the striking things on that is the booster uptick is around 1 to 2% in many areas and I probably didn't necessarily believe a lot of the data that were getting. But that 25% that didn't, I thought, wow, there's at last some honesty with the figures. And I guess you looking at these figures of the last three years, there's been massive scepticism of the information we're being told. Well, I'm glad you mentioned that because as the COVID Community States Program, which was an academic epidemiologic program, as they were reporting 25% unvaccinated, the CDC at that time was reporting 8% unvaccinated. Well, what's the difference? And the answer is the CDC was over counting. If patients forgot their vaccine card, they went to a different pharmacy, they could have had a new card started at the booster stage and been counted again. So we now know that the CDC does not have accurate vaccination data. There tended to be overestimating vaccination. Our CDC is currently reporting 16% booster uptake, and that's almost certainly an overestimate. We need to know booster uptake by time. Because the boosters only last theoretically six months. Clinically, it's about half of that. So no matter who took a booster more than six months ago, they're effectively unvaccinated. Yeah. If I can just discuss some of the things you've posted, even just the last week on Twitter, and of course, if people go to your Twitter handle, they can get the link to your Substack, the website, everything is there and encourage people to to sign up. Certainly your Substack, which has been a fantastic source of information for many of us. And one of the actually it was America Outloud.com, which I know you write for, had the headline you put up a few days ago was try to vaccine injury syndromes converges on victims. It said amongst the most common and frustrating COVID-19 vaccine injury syndromes are small fibre neuropathy, pleurodynia and POTS, which I can't even pronounce what's there, and you had a lady who came on and acted as if she was going to see her doctor and discussed what, but tell us about some, because we hear all different side effects and we'll maybe touch on myocarditis a little bit, but it was those three coming together and it seems to be every week, every two weeks, there's another issue that comes up. It's true, but this triad that I pointed out far and away is the most common constellation. I've been seeing patients now with vaccine injuries now for two years, you know, steady flow in the clinic, so I really have a good handle on this. And so the triage is the following. One is pleurodynia, just some nonspecific chest pain. Sometimes it hurts to cough or take a deep breath or laugh. Sometimes when they put pressure on the chest, one can feel pain, which is called pleurodynia. The next one is a small fibre neuropathy, that is feeling numbness and tingling, prickling in the hands and the feet, usually sometimes the back of the legs. And then the third is POTS or Posterior Orthostatic Tachycardia Syndrome. And patients will recognize this because their heart rate unexpectedly will shoot up when they're doing nothing, then go down. Blood pressure up and down. When they exercise, things seem to be out of proportion to what they need in terms of exercise, and they feel generally unwell. And so I was lucky enough to have a patient reach out to me. She's very sophisticated, and she gave consent, and she told us her story and she had that triad. And I went through the questions I would ask her, the tests I would order to rule out serious problems like myocarditis, like major problems in the central nervous system, et cetera. And then what medicinal empiric approach would I take? And for the pleurodynia, the drug I prescribed the most is called Colchicine. This is a form of an anti-inflammatory. There's about two dozen trials in acute COVID-19 showing that it plays a role. So we know it's helpful there. The largest one of note's called the CO-Corona trial done out of the Montreal Heart Institute, over 4,000 subjects, probably the best and largest outpatient COVID study. So colchicine is also used to treat gout and forms of inflammation. So it seems to be very important for the pleurodinium. For the POTS, the posterior orthostatic tachycardia syndrome. That's actually too much adrenaline being released from the sympathetic chain of ganglia in the neck as well as the adrenal glands. And I found that it was a relatively underutilized beta blocker called Natalo, which has what's called intrinsic sympathomimetic activity. It seems to modulate the alpha and beta receptors just the way we need in order for that nervous system feedback loop to the brain to be corrected. And then the final triage in this entire problem is actually dissolving the spike protein itself, which is loaded up with COVID-19, the illness and serial vaccines. Remember, we get spike protein in our body, we can't get it out for months, if not a year or more, after the infection, as well as the vaccines. Each shot of the vaccine installs large amounts of spike protein. There we're utilizing nattokinase. Nattokinase is a natural enzyme that's derived from the fermentation of soy is discovered by the Japanese. A bacteria that breaks it down is Bacillus subtilis natto. And it creates this fermented product as an enzyme. The Japanese have been using it for over a thousand years. That is eat consuming natto. But we now have a supplement they've used for about two decades. They use it for cardiovascular applications. a form of a blood thinner, so it's a serious supplement to take. The current recommended dose is 2,000 fibrinolytic units or 100 milligrams twice a day, it's well within the range of safety. It's been safety tested up to 80,000 units at a single time, so it's well within the safety limit. The caveats are bleeding, mucosal bleeding from the nose or mouth, and then a soy allergies. Otherwise, it is a safe supplement. It's not immediate that this three-component therapeutic program works, but most patients after two months, they start to come back and they start to feel like they're on the way back. So I wanted to share that. Many of the doctors that are sought out nowadays are with The Wellness Company. I advise that company as a chief scientific officer so they're well aware of that approach. But I have to tell you, that's my most common approach I use in clinic and I'm glad we finally found something that can help people through this. I've tried hydroxychloroquine, ivermectin, fluvoxamine, prednisone, a whole variety of different drugs and I've really settled on these three. Two prescription drugs and then one over-the-counter supplement. That's really helpful. And I think many people are concerned that if they did have any of these and they went to see their normal doctor, that actually in the doctor's mind would not be thinking that actually these could be related and therefore their concerns could be dismissed. I agree. The first question a patient should ask a doctor is, did they take the COVID vaccine and did they push it on their patients? And if they did, the patient ought to have a serious conversation with it because that doctor made some grave mistakes with his or her own healthcare and obviously pushed a dangerous vaccine on their patients. And we now know large numbers of people have died after the vaccine, have suffered injuries or disabilities, and those doctors really owe their patients an apology. There was another tweet, you said, most people with long COVID are vaxxed, so multiple spike protein exposures are making Americans sick. And I know I've talked to UK friends and US friends, they seem to think the solution to long COVID is getting a booster and another booster. And tell me, tell us about that, because people are ill and with long COVID and some people it's quite a dark journey. It's true. Long COVID, remember this occurred before the vaccine, so the respiratory illness clearly causes it. It almost exclusively occurs in people who are sick enough to be hospitalized, about 50% will have it. They feel generally unwell, weight loss of skeletal muscle, hair loss, skin and nail changes, headache, ear ringing, fatigue, brain fog. It really bothers people. Now, with lesser degrees of severity of COVID, there's less and less long COVID. The best way to prevent it is actually early treatment. If we can snuff out the virus very early and get relatively little exposure to the virus in the body, that's the best way to do it. We again believe what's driving this is the pathogenic spike protein, the SARS-CoV-2 spike protein. Now, the vaccines install more spike protein. So there's no way the vaccine can make it better. It's going to clearly make it worse. But what we have in many countries, a good example is Australia, I was just there a few months ago. Virtually all of Australia was pre-vaccinated. They were all pre-vaccinated. Because the vaccines don't work, they get COVID anyway. So those who are having long COVID, it's far more severe in Australia because they've been pre-vaccinated and they've been loaded with the spike protein. So then we have to work our way out of it. But I wouldn't want anybody to think we should take a vaccine to reduce the chances of long COVID because the vaccines don't work, people get COVID anyway, and it just makes the long COVID syndromes worse. And so as we sit here today, a paper by Claussen and colleagues from Harvard suggests that 94% of Americans have already had COVID. I've already told you 75% took vaccines. So anybody with long COVID likely has had both exposures. Yeah, absolutely. There was another study or news piece from Trialsite News and that was on maternal mortality skyrocketing, gestational thrombotic complications up and MRA in the breast milk. And I think the MRA in the breast milk, that should fill a lot of people with big concern. I know that's been talked about before, but I mean, tell us about this because you end that tweet by saying COVID vaccine should never have been allowed in pregnant women. Early in 2021, Dr. Raphael Stricker in San Francisco, who runs, by the way, the largest fetal loss centre in the United States, he's an expert. He's an allergist, immunologist, but he's an expert on pregnant women and losing their babies. And Dr. Stricker and I published in trial site news that the COVID-19s were vaccine category X, and that's a regulatory category saying that they have a dangerous mechanism of action. They install the lethal spike protein in the body, and we have no experience in pregnant women. They were excluded from randomized trials and no assurances would be safe to the woman or the baby, none whatsoever. So it's pregnancy category X. It's very important. Pregnant women should have never taken the vaccine. Never, never. It doesn't matter what the doctors say. Pregnant women are responsible for themselves, their bodies, and their babies. Now, pregnant women have a lower risk of severe COVID outcomes as shown by Pinellas and colleagues in a paper in Annals of Internal Medicine. So, we weren't worried about pregnant women. If they got severe COVID, they're treatable, you know, and we can treat them with an array of drugs. By the way, hydroxychloroquine, very safe in pregnancy. We've, you know, it's been actually dedicated pregnancy studies with hydroxy. So, so we know for sure it's safe, as is aspirin, prednisone, and the other drugs that we normally use. Now, what's coming out is very, very disturbing. First, last summer in JAMA, a paper by Hannah and colleagues showed that breastfeeding women who take the vaccine, they actually are transmitting the messenger RNA through milk to the babies. And this is a terrible, very worrisome finding. Now genetic material getting into the bodies of recently arrived babies in the world. No idea what this is gonna do to the children. It can't be good. It's definitely not natural. The next piece of information came, first author is Hoyert, a single author paper, analysing data from the National Centre for Health Statistics. And there, it's published on the CDC website, March of 2023, showing record maternal mortality. That is, women dying during pregnancy or 42 days after the pregnancy. That was the definition according to their highest risk group, African Americans, but at all groups. They've erased progress in maternal mortality. Now, in the same sub-stack, I juxtapose the CDC report that indicates 65% of pregnant women have either taken the vaccine, ill-advised, before or during pregnancy. Despite our warnings that it's pregnancy category X, now we have the tragic case that unfolded last week of the death of U.S. Olympic sprinter Tori Bowie. And what we know there is this is just absolutely terrible. She's found dead at home, and she's seven months pregnant. The U.S. Track and Field Association has mandated COVID-19 vaccination, so they've been silent now. USTAF and family have been silent on whether or not she took the vaccine. But the concern is that she took it, and she had a fatal complication, either blood clot, heart damage, or some type of intracranial catastrophe. Wow, wow. And of course, we have learned, I think just could have been yesterday, about the reactivation of federal funding for Eco Health Alliance. To touch on that, because obviously, your government, our government, they haven't learned anything over these last three years. I think it's very intentional. Peter Daszak, who's the president of the Eco Health Alliance, they're basically an NIH contractor. They work with academic groups. They take the blueprint for viruses that are basically engineered in the lab by computer modelling by US researchers, and then they shuttle the plans over to the Chinese or other Asian countries where the the work is done in order to create new viruses. Daszak was involved in shuttling over the plans from Ralph Baric to create the chimeric SARS-CoV-2 virus. And Baric published this in 2015 in Nature Communications and proceedings of the National Academy of Sciences. They created SARS-CoV-2 and published the methods and how they did it, chimeric parts, of a virus from a bat, parts of a virus from a known coronavirus in order to get it to invade a human respiratory epithelial tract. Peter Daszak, early in 2021, led a group of doctors. After they had met on a conference call with Anthony Fauci and Francis Collins and Jeremy Farrar from the Wellcome Trust in the UK, Daszak led a group of authors to publish one of a series of papers. It was a dozen academic papers that were intentionally fraudulent. They were deceiving the public, describing the virus came out of nature when Daszak himself knew it came out of basically his plans that he drew up with Ralph Baric at the University of North Carolina Chapel Hill. This was an intentional cover-up campaign. This came out in the U.S. House Select Committee for the Coronavirus Origins, led by House Representative Comer, and it's shocking that the NIH, and actually the branch that Fauci used to lead, the National Immunology Infectious Disease and Allergy Branch, that they actually released his former R01 grant. His R01 grant was distilled to look among different bats to try to find viral strains that could jump into humans. I mean, it's just simply asking for trouble. Daszak is off, and you know, these are small grants, it was only about $500,000. It's not the size of the grant that matters, it's the fact that he's going to be able to now shuttle academic capital to Asia. Daszak says that now he's going to take this to the Duke University branch in Singapore, but the grant describes the bat caves in China going right back to the same work. So you're right. It appears as if the NIH is wilfully blind to this active cover-up. They don't care. They're pursuing this biological threat research. They must have been given orders high up to continue to do this. We have the National Security Administration, the FBI, Department of Energy and NIH, the House and the Senate all agreeing that the origin of SARS-CoV-2 was the lab. It was a US innovation contracted to the Chinese, and it leaked out of the lab in Wuhan, China. But to continue to pursue this, many are saying, and I agree, that it's reckless, it's irresponsible, and it really shows deep complicity that the biopharmaceutical complex is at work creating more biological threats for the world. And Peter Daszak is leading the way. Well, let's certainly watch what happens on that. On the, back to the specific medical side. You had written a piece on your website, and I think the headline was, myocarditis not recovering 80% at six months after vaccination. Tell us about it, because again, people are expecting that the body can recover quickly, but this says that only 20% of people with that had recovered over six months. Another disturbing report, this comes from Yale School of Medicine. They had 17 young teenagers in the hospital with myocarditis. Remember, teenagers should be going to high school. They shouldn't be hospitalized with myocarditis. They ill-advised took one of the COVID-19 vaccines and they got in deep trouble. Sky-high troponin levels showing heart damage, probably had chest pain, shortness of breath, arrhythmias, other manifestations, and they undergo serial MRIs. Now, they did rule out any exposure to COVID, so that was very clean. This is purely due to the vaccine. And they found that in 80%, the MRI at 200 days was not getting better. 20% it got better. You know, these small areas of late gadolinium enhancement that we see on MRI, they should resolve. Previous work done years ago by Bruckman and colleagues from Germany showed that the heart can remodel a small area of inflammation. I'm concerned that the genetic material, Pfizer and Moderna, is sufficiently long-lasting, the spike protein long-lasting, the body keeps producing more of it, that the children have ongoing cardiac injury and it's not clearing up on MRI. This could leave some to have a scar, and when they have a scar they could be at increased risk for two things, heart failure later on in life or cardiac arrest, particularly with sports. Wow, and on sports, we've seen a number of sports stars. The papers seem to be regularly full of another sports star having retired early or having complications. I mean, tell us about, because the stories are there, but maybe the dots are not necessarily being joined up. Well, let's take the issue of death in young people. There's a paper on my substack that I quote from about 15 years ago, and you can find it on the Courageous Discourse sub-stack, but it was basically describing death among college students. It does happen rarely. But the point of the paper was 87% of the time, we know the cause of death. Readily apparent, you know, cancer or suicide or homicide or a drug overdose, motor vehicle accident. What we're seeing now is scores of athletes, scores, sudden death and no explanation, no explanation at all. And it's called died suddenly, Edward Dowd has compiled an entire monograph on this in the life insurance roles of sudden unexplained death skyrocketing, mortality skyrocketing in every system. John Stockton, former Utah Jazz star, is keeping track of the athletes in the United States and there's hundreds now that have died, have died on the court or in practice. It seems to be the adrenaline that precipitates the sudden death with vaccine-induced myocarditis. And we knew actually before the COVID vaccines that we can't let young people with myocarditis exercise because it will trigger a sudden death event. So we knew this ahead of time. And what's happened is the sports teams have mandated the vaccines, but they haven't provided any safety safeguards for the athletes. And so they suffer heart damage. And then during competition, we never know who's going to have a cardiac arrest. Polycritus and myself analysed this issue, using really just a blog, a public blog of European athletes went down. But it's pretty rigorous. There had to be four or more reports, and you could easily identify that the athlete went down. And the data showed this, that before COVID-19, in the stable period of about 10 or 15 years before COVID-19, the number of cardiac arrests in Europe in the professional leagues, mainly soccer and rugby, but you call football. Age 35 and below, pro and semi-pro, number of cardiac arrests 29 per year. Now, fast forward with vaccination and in 2021 forward, that number came out now, you know, comparing apples to apples, 283. So there's about a tenfold increased risk of sudden death with mass-mandated COVID-19 vaccination. We have clear fatal cases of the COVID-19 vaccines causing myocarditis and sudden death with autopsies, so we know it's happening. And now the great concern is so many athletes have taken it, and they want to know what to do. They have great regret. It's been an absolute horror for our athletes unnecessarily to be vaccinated. A story that came out just today, and again we're seeing headlines that we wouldn't have seen a year ago, I think you're probably the same there, but the headline was, I had to reread this four or five times, the headline in the Daily Mirror was, Brits are dying in their tens of thousands and we don't really have any idea why. And they talked about between May and December 2022, that 32,000 excess deaths. And to have a headline that honest, we really have no idea. That's telling. And I'm assuming, I don't know whether it's in the States, whether you are beginning to, the media are beginning to drop little headlines like that in to begin to have the conversation or not yet. No, it's starting to happen. I was on national TV this morning and the morning anchor mentioned death after vaccination, so it's starting to come up. What we know is that every mortality system is reporting skyrocketing mortality, primarily of younger individuals. A paper published by Skidmore in BMC Infectious Diseases estimated in 2021 that 278,000 Americans had died due to the vaccine. And that matches roughly what VAERS was reporting for that year with a multiplier of about 30. It's very consistent with a paper from Columbia, same year, Pentecost and Seligman. So we have multiple sources of data. We think we lost about a quarter million Americans in the first year of the campaign due to the vaccine, a similar number in the next year. We may be over 600,000. Now, that's going to exceed the amount of casualties we had in the civil war. So this is a very, very serious problem. The vaccines were considered a wartime countermeasure. So the government agencies didn't consider it a public health measure. It's not considered like a standard pharmaceutical. It's considered like basically a war initiative, where there's going to be casualties. And boy, have there been casualties with this vaccine. So, before COVID, the general mortality that we had in the United States, or in UK for that matter, is known. And then it's 40% known antecedent heart disease, 40% known cancer, or 20% other causes. But in the vast majority, it's known. Death is not a mystery in our countries. And what we're seeing now is just a large fraction where they've taken a vaccine and they've died, and the official cause of death is unknown. And when autopsies are done, two papers, one by Schwab, one by Chavez, and there's been probably about 100 necropsy studies that we're compiling at this stage, they show that when an autopsy is done, 70 to 80% of the time, they have a clear-cut cause of death that's, related to the vaccine. Fatal myocarditis, fatal intracranial haemorrhage or clotting, blood clots and pulmonary embolism, or one of the fatal immunologic syndromes. These are published in well-described vaccine-induced thrombotic thrombocytopenic peria, multi-system inflammatory disease. So we have a huge scientific base that's indicating the vaccines are essentially killing large numbers of people worldwide. And is it possible that we could get to the point where any of these companies are liable for it, or is it irrelevant who's in the White House because they've been given that protection? People have said that two conditions may ultimately drop liability shields. The broad liability is not only from the 1986 Vaccine Indemnification Act, but also from the 2005 Prep Act, which says, listen, if we have an invasion of SARS-CoV-2, it's like a war. And so the wartime countermeasures are all, you know, have immunity. But the, two conditions are fraud, that if the public was defrauded by the vaccine manufacturers or the government agencies that were advancing them, the employers that were forcing them. And then the other is actually malicious intent, that indeed, if it was intentionally designed to be harmful, maybe documents would, you know, identify intent. But fraud and malicious intent are the two things that lawyers are looking at most closely. Because, you know, some of these cases are very obvious. Some take the vaccine, they die right in the vaccine centre, or they die the next day. Now, in the UK, as well as the United States, our government, by the way, holds both datasets. They have the entire death database, and they have the vaccine administration database. And if they merge them, we can see how many people die in the first day, in the second day, and look at the temporal relationship. Any death within 30 days, according to regulatory practice, should be assigned to the new drug, in this case the COVID-19 vaccine. And what's the, I mean, I had Tom Fitton on a few days ago from Judicial Watch, and they use freedom of information requests, which we have the same system here. They use it at another level than I've seen before. But will that have to be used as a way to get the data? Because obviously some of the data that had been released from Pfizer, there's so much and it's still been gone through. Will it have to be other freedom of information requests to get more of this data to actually put the jigsaw together. It's true. Well, you point out that the pharmaceutical companies kept their own separate safety data by obligation to the U.S. FDA for 90 days after release. So anything that happens 90 days after they release the product, they have to record everything. Pfizer had recorded 1,223 deaths within a few hours or a few days of taking their vaccine. So it should have been off the market in January of 2021, and Pfizer did not want to release that to the American public. They got a lawyer. The lawyer for the FDA wanted to block it for 55 years. So that was evidence that the US government is colluding with Pfizer to basically hide safety data in the Pfizer vaccine. Moderna still has not released their 90-day data, neither has Janssen or Novavax. So immediately, there should be strong calls for release of the safety data. It should be done under the prosecutorial power of the U.S. Congress, Senate, Department of Justice, Freedom of Information Act, but that's pretty slow and that's citizen-driven. We need our government agencies to step up and have the companies release the data. I mean, I want to know, is Moderna the same or even worse than Pfizer? I suspect it is, because all the studies that directly compared Moderna and Pfizer show greater toxicity with Moderna. There's a paper by Busby and colleagues on myocarditis that showed that. So, you know, our regulatory agencies, FDA, CDC, NIH, MHRA in the UK, and TGA in Australia, they have grossly let us down. They're actually participating in a fraudulent cover-up of a worldwide COVID-19 vaccine safety debacle. Just my final thought about you as a medical professional, and I've talked to UK doctors and they find it extremely difficult. Those who have spoken up, they've been punished. They've been pulled in front of disciplinary committees. And I know you've suffered as well. What is what is that like? And can doctors be vocal about their concerns or really have many had to stay quiet and how has it affected you? Doctors all need to step up. People are dying. They've died with the virus, untreated, and they've died now with the vaccine. This is not a time for doctors to be silent. They need to be bold and relentless, bring the truth forward. I haven't had a single doctor of my medical standing, the chief of medicine or division chief in cardiology or other medical specialty, actually ever look me in the eyes or send me an email or give me a call on the phone. Not a single one. They're absolutely ashamed of themselves. And I've had attacks from anonymous fact checkers making false claims. I've had attacks through certified letter or email, essentially trying to strip me of all my credentials. And every one of these attempts, I just get stronger. I've got a very, very strong voice out there in the world right now, and everybody knows it. I've given more media analysis. I've done more publications, more stage presentations on this issue than all the public health officials combined. And you can't find an area where I've been wrong or where I've been inconsistent. My views have changed as the virus has mutated, but I've been accurate and you know, the world knows it. And because I have so much media exposure, I have more than the public health officials. The world is coming to me and doctors in my circles for the truth. I think these government agencies and the biopharmaceutical complex is in trouble, and they're looking for the exits right now. We've had Francis Collins, head of the NIH, retire prematurely. Anthony Fauci, head of NIAID. We've seen now Rochelle Lewinsky, just two and a half years in the CDC, and a young woman, very junior, now leave the CDC. People are heading for the exits because they know they've committed wrongdoing. Dr. Peter McCullough, thank you so much for your time today. It's an honour to speak with you. Thank you. Thanks for having me. Be sure to follow me on my website, petermcullochmd.com. Make sure you check in my podcast, McCulloch Report on America Out Loud Talk Radio, 2 p.m. Eastern, Saturday and Sunday on the Apple iHeart Podcast Network starting on Tuesday. My book, Courage to Face COVID-19, and I'm starting a new TV show, full investigative TV show in Dallas on AFN Network with bestselling author John Leake. It's called The Second Opinion. I'll see you there or start in June. Thanks so much for having me on the program.

Can you feel the earth shaking? That's Dr. Dovec and Hannah buzzing over their new adventure with BodyByBariatrics Weight Loss & Bariatric Surgery Program!The DoctorXDietitian collab have officially opened their (virtual) doors to offer comprehensive medical and surgical obesity treatment options.Here, they describe their liberating journey that has been chock full of highlights and lessons.Dr. Dovec and Hannah, RD are disrupting the way obesity is treated. They are uncompromisingly focused on personalized care experiences and sustainable results. Their services cover everyone from the novice to the seasoned weight loss veteran. This podcast spans the personal (spice rack, anyone?) to the professionally bougie. Listen in for all the deets!

The Commanders are about to sell for 6.05 billion dollars. That's Dr. Evil money, son! Fitting when it comes to Dan Snyder. Meanwhile, OBJ is a Raven and Rodgers is still a Packer.

From an Edmonton MP's visit to Ukraine, to a broadcaster's battle against an online harasser, to the UCP's plan for healthcare, this is a Real Talk episode you'll want to catch from start-to-finish.  3:15 | Heather McPherson's just back from Ukraine, where the Member of Parliament for Edmonton-Strathcona met with diplomats and civilians amid Russian attacks. She tells us about what she saw there, how it shaped her opinion on supports from Canada. The NDP MP also chimes in on Chinese interference in Canadian democracy, including where she says the Prime Minister's falling short.  19:39 | It's a big day for broadcaster Jody Vance. She joins Real Talk an hour before facing her harasser in court. Jody tells us how it all started, why she pressed charges, what she makes of his guilty plea...and she says his name out loud for the first time, right here on Real Talk.  36:00 | Underfund, criticize, privatize. That's Dr. Rebecca Graff-McRae's assessment of the UCP plan for healthcare in Alberta. The Parkland Institute research manager takes us into her feature in the March issue of Alberta Views, and explains why the province's healthcare crisis isn't even close to being fixed.  SUBSCRIBE TO ALBERTA VIEWS: the promo code AVRJ knocks 50% off a one-year, ten-issue subscription at https://albertaviews.ca/subscribe/ 1:16:03 | Adam's sick of hearing about "rage farming," and Gabe says there's no such thing as the "far left" in Canada. Both of them blow off a whole bunch of steam in this week's edition of Trash Talk presented by Local Environmental Services!  KEEP IT LOCAL: https://localenvironmental.ca/ WEBSITE: https://ryanjespersen.com/ TWITTER: https://twitter.com/RealTalkRJ INSTAGRAM: https://www.instagram.com/RealTalkRJ/ TIKTOK: https://www.tiktok.com/@realtalkrj PATREON: https://www.patreon.com/ryanjespersen THANK YOU FOR SUPPORTING OUR SPONSORS! https://ryanjespersen.com/sponsors The views and opinions expressed in this show are those of the host and guests and do not necessarily reflect the position of Relay Communications Group Inc. or any affiliates.

1,300 egg retrievals in 2022. That's not one practice. That's Dr. Roohi Jeelani. Dr. Jeelani joins the discussion this week to share how her unending work ethic and incredible social media presence has changed her practice, improved patient relations, and why she believes this paradigm shift is here to stay. How did this REI end up doing more retrievals than any other doctor in the country? Tune in to this week's episode to find out. Listen to hear: How changes surrounding patient contact evolved during the COVID lockdown era, and why they may be here to stay. How the use of social media has opened the door to a new world of direct contact from patient to provider, and what that paradigm shift means for both patients and their providers. Griffin question whether this change is a good AND a bad thing at the same time, whether or not it has the potential to thwart the chain of command throughout the treatment process.a How Dr. Jeelani uses her social media presence to increase productivity through patient education, and how she believes that empowering patients with information is the key to success.

“Take accountability, make great suggestions, and be part of the solution.” That's Dr. Angelo Venditti's approach to supporting the well-being of his team members. As Chief Nurse Executive, Chief Patient Experience Officer, and EVP for Patient Care Services for Temple Health, Angelo is passionate about empowering people to play a key role in the quality of their employee experience. In this episode, Angelo, and our guest host, Michelle Doran from CCA, discuss how to provide your teams with the tools and services they need so they can take ownership of their workplace experience. Listen in to learn about coaching and encouraging people in a way that shows while challenges may exist in their professional journeys, they aren't insurmountable. Book Recommendation: Black Like Me by John Howard Griffin Additional Resources: Connect with Dr. Angelo Venditti: angelo.venditti@tuhs.temple.edu Learn more about CCA: https://ccainc.com  Listen to Cy Wakeman's Episodes on Conscious Habit Learn more about the PeopleForward Network: www.peopleforwardnetwork.com

Dr. Alex Gee reflects on the true nature of being a victim, as he is accused of taking advantage of victimhood. He reflects on what a victim complex looks like and flips the definition on the white troll to consider the insecurities of white supremacy. Dr. Gee points to the excellence and resilience of his family to dispel alarmist victim-shaming. You are going to want to hear this! alexgee.com Support the Show: patreon.com/blacklikeme Find out more about the Justified Anger Black History for a New Day Course and how you can get involved: nehemiah.org/our-work/justified-anger/  

In a very busy news week, Anthony Di Marco joins the show to discuss what could be going on with Edge being banished from his own group and Riddle's Universal Championship match next week.Hey guys check out our sponsor and the Dr I actually love to see! It's where I get all my CBD from & the website is DrGanja.com they have a huge selection of cbd & hemp based products including cannabinoids such as delta 8, delta 10 delta 9, thca, thc-o, thcp, hcc and so much more! They ship for free with in the U.S. and offer international shipping as well! That's Dr.Ganja.com and use the coupon code "WWE" at checkout for a nice discount!

Who is Dr Troy?We talk about strategic planning, aligning teams and getting them to their One Destination.Key Takeaways1. Too many leaders don't know how important it is to have a singular culture to drive the organisation to one destination2. Leaders must engage in this process and need to make personal observations in three areas. Greetings. How are people interacting with each other? What are they saying? Who are the people who are actually talking to each other? Listen for laughter. We're talking about the light-hearted spirit within the organisation. Is there a lot of stress or burnout happening? Can you tell whether individuals are feeling comfortable? Do they feel relaxed, they feel confident? And then lastly, affirmations. How are you affirming people? How do people affirm each other? Do you have individuals who are complimenting other individuals in their own department or in other departments? What are the colleagues and peers relationships? Valuable Free Resource or Actionhttps://DrTroyHall.com/servicesA video version of this podcast is available on YouTube : ————————————————————————————————————————————-Subscribe to our newsletter and get details of when we are doing these interviews live at https://TCA.fyi/newsletterFind out more about being a guest at : link.thecompleteapproach.co.uk/beaguestSubscribe to the podcast at https://link.thecompleteapproach.co.uk/podcastHelp us get this podcast in front of as many people as possible. Leave a nice five-star review at  apple podcasts : https://link.thecompleteapproach.co.uk/apple-podcasts and on YouTube : https://link.thecompleteapproach.co.uk/Itsnotrocketscienceatyt!Here's how you can bring your business to THE next level:1. Download my free resource on everything you need to grow your business on a single page : https://link.thecompleteapproach.co.uk/1pageIt's a detailed breakdown of how you can grow your business to 7-figures in a smart and sustainable way2. Join The Complete Approach Facebook Group :  https://TCA.fyi/fb Connect with like-minded individuals who are all about growth and increasing revenue. It's a Facebook community where we make regular posts aimed at inspiring conversations in a supportive environment. It's completely free and purposely aimed at expanding and building networks.3. Join our Success to Soar Program and get TIME and FREEDOM. : https://link.thecompleteapproach.co.uk/Success-to-SoarIf you're doing 10-50k a month right now: I'm working with a few business owners like you to change that, without working nights and weekends. If you'd like to get back that Time and still Scale, check the link above.4. Work with me privatelyIf you'd like to work directly with me and my team to take you from 5 figure to 6 and multi 6 figure months, whilst reducing reliance on you. Click on https://link.thecompleteapproach.co.uk/DiscoveryCall  tell me about your business and what you'd like to work on together, and I'll get you all the details._________________________________________________________________________________________________TranscriptNote, this was transcribed using a transcription software and may not reflect the exact words used in the podcast)Stuart Webb 0:20 Oh, well, brilliant. Hey, welcome to It's not rocket science five questions over coffee I'm, I'm here with Dr. Troy, Dr. Troy Hall. Dr. Troy just had a huge few technical issues, which is the wonder of the internet. And I was just a little bit concerned. But we're here today, I'm really glad to meet to have you on the podcast. Dr. Troy, welcome.Dr Troy Hall 0:42 Thank you so much for having me.Stuart Webb 0:44 And my apologies for the fact that we have that sort of new few moments of technical issues, it's gonna be good. It's always better when we have technical issues.Dr Troy Hall 0:53 What Yes, it is, normally most people want to meet me, not us. So.Stuart Webb 0:58 So Detroit offers consulting, coaching and speaking engagements of our culture, leadership, strategy change with a huge area of experience, you just have to try and really enjoy a conversation. So let's start with the obvious first question. So who is your ideal client? What was the problem they got that you're helping them to solve,Dr Troy Hall 1:20 or most of the clients that I work with, believe it or not, have, have made progress toward creating this very important aspect of culture within the organisation. So my ideal client is the person who understands that culture is important in an organisation who believes that their employees are their greatest assets, and wants to make sure that they do everything possible to create the very best culture experience. And I work with small companies, again, 50 employees and less, and I have a companies I've worked with, with 1400 employees. So the idea is about the not the number of people or the asset size, it's the mindset of the leaders that really make the difference. And so part of my work is helping them create cohesion cultures, which is safe workspaces, where people have a sense of belonging are valued and sharing mutual commitments.Stuart Webb 2:13 And that's a really important element, isn't it? The mindset, the the leadership, have translating that into the actions that people see in the behaviours that they model, those are really big area there have work to be done?Dr Troy Hall 2:26 Absolutely. Because here's the deal. For people who really need me, they tend to not not call on me, the people who have things already put together and are doing really well. They're the ones who call me because they understand that they are teachable, they need to know some more information, they want to take it to the next level, those are the individuals that that typically I get an opportunity to work with. And I'm very clear, I only work with organisations when the CEO is behind the project. If the CEO is not on board, then there's no point in even going any further because my reputation and the company's reputation remains at risk.Stuart Webb 3:03 Really important stuff. Let's let's talk about that next thing, then, which is those people that you know, have tried to solve these problems, maybe the CEO is aware that they need to do something to bridge the the mindset culture gap. And they've tried to solve it without calling Dr. Troy to start with what what is the what is the sort of symptom of the organisation that you first go in and see where they're thinking, we need to do something here, we're just not sure what it is?Dr Troy Hall 3:28 Well, the first thing I do is I ask the leaders to engage in this process, because I think it's very important that they have a perspective, you know, to guide people toward perception. And perspective requires us to really see things from the same point of view. So I asked them to look into their organisation that they think they already know a lot about. And I want them for two to three weeks to really make personal observations in these three areas. One is Greetings. How are people interacting with each other? What are they saying? Who are the people who are actually talking to each other? Do individuals just walk in in the morning and go directly to their desk? They have some greeting? Do they have some sort of way in which they connect? What's the relationship? What's the report happening? The next is listen for laughter. Now, let's not the heart heart heart hit unique kind of laughter that we're talking about here. We're talking about the light hearted spirit within the organisation. Is there a lot of stress or burnout happening? Can you tell whether individuals are feeling comfortable? Do they feel relaxed, they feel confident? And some of that comes within that lightheartedness that happens within the organisation in the relationships of people. And then lastly, I look for affirmations I asked them to say, tell me, how are you affirming people? How do people affirm each other? Do you have individuals who are complimenting other individuals in their own department or in other departments? What are the colleagues and peers relationships? Do you even have an internal process that allows you to, to really celebrate the small wins of individuals who are within the organisation. So it's greetings. laughter and affirmations.Stuart Webb 5:10 That's really interesting. I love the way that you've broken it down there. Because for me, actually, it is those first few minutes particularly now is we're in organisations where we're dispersed, we're no longer necessarily meeting together, face to face, we sometimes hear on these calls and such like, it's whether or not people have got the ability to just for the first five minutes of a meeting, just greet each other and say hello and build a rapport. See, the real strength of an organisation, isn't it, that's when you really begin to understand if people value each other, or whether it's just, I just come in, I do my job. And I want to get away from here as soon as I can.Dr Troy Hall 5:46 Yes, I was on a field engagement in Prague, and I had an opportunity to meet with some of the leadership of Duke manufacturing there. And that is a key component greetings are a key component of that organisation. And they make sure that the senior leadership is engaged in that process of greeting individuals, wherever they see them, whenever they see them. They don't just look at them or, or not, or, or even look down sometimes when you when people pass each other in the hallway, do they actually make eye contact? Or do they look down to the look away? How do they extend some sort of communication that really is going to tell you a lot about the real, the real underpinning of values within your organisation. And for Duke manufacturing, that was extremely important. And that came that resonated through within their production work within their core values and how they really integrated everyone into their team.Stuart Webb 6:37 So I suspect them to try we're going to learn something about the next question with with what scrolling across the bottom of the screen here at the moment. But But what's the sort of valuable free resource or valuable free action that you provide to the audience that would help them start their journey?Dr Troy Hall 6:52 Well, they can go to my website directly, which is on the screen there. And it's Dr. Troy Hall calm, and they can take what is called a culture quiz. And so they got 10 basic questions that they can answer very quickly, that gives them maybe a feel for what their organisation is like, I respond with an email with an attached PDF. And in that PDF, I give you some tips that you can actually put in place immediately right now get started. And then you can connect with me to actually build out your programme. And then we can do a more expansive, what I call culture assessment within your organisation to give you a benchmark, and a series of things that will make sure that what you're creating is your unique culture. Everything I do is all customised to the company. We take the strategic framework of belonging value and shared mutual commitment, overlay that to the organisation, and then figure out how to customise what that organisation wants to do to bring their culture to life.Stuart Webb 7:53 Brilliant, love it, I'm not to coach a quiz, I'm going to probably going to plug in and get some of my clients to do as well. So do try hall.com. That's Dr. Troy hall.com. And that's a great, great offering. Thank you very much, Dr. Troy. So my last question at this section is, is what's the great book or concept or talk that's really affected you that you think would would value the audience hearing about and and turning to a better their own practice?Dr Troy Hall 8:22 Well, aside from self promoting my own book of Asian culture proven principles to retain your top talent,Stuart Webb 8:28 well known as a given we're expecting,Dr Troy Hall 8:31 oh, wait, yeah, that'd be a given. Right? So aside from that, I have had so many books that have made a difference in my life. And it's really hard to put my hand just on any one of them. But I will tell you that something that really helped me expand my thought was a book called Generation I Y. And it was written by Dr. Tim, something I forget his last name right now. But the book what he did is it talked about this transformation of the digital world and how the millennial generation was the first generation to surpass its parents, not only in the knowledge, but the use of technology. See technology is the great equaliser when it comes to all businesses. It's that that that technology, and what we're seeing today is so different than what it was before. So I think that generation i y was is one of the books that I would definitely, I mean, there's so many of them. There's the Dale Carnegie book that I've read, Tim Ross, strengths finders, and there's a lot out there.Stuart Webb 9:42 That wasn't great. There are some great books out there. I must admit, you know, it's a great, great pleasure I have I spent about half an hour each morning, just centering myself on what I'm going to be doing for the day which involves some sort of units of thinking and planning, but I actually spend about 1520 minutes just going through a few choices. Some texts, yes, key things and and that's what I'm now going to add what other than your book, obviously Dr. Troy will put that one on the list as well. But I'll add that one to my list to make sure I pull on that one. So it's a great recommendation, thank you so much.Dr Troy Hall 10:14 Well, you're welcome. And you know, one of the things I want to give a tip to your listeners is this, you don't have to read a book from cover to cover to be able to acknowledge it or quote it, find the pieces, find the gems that are there for you in the book, like look through the index, see what sparks your interest, fill your mind with that. Also inspirational information that will come through podcasts that will come through messages where you might follow someone or LinkedIn and follow a leadership programme. And you know, and I fail to mention, you know, Simon senex, work and Brene Browns work, which is really great in this whole area as well. So don't be afraid to find a collecting pieces here and there from the books. And if you do choose to quote it, give credit to the author. But it doesn't mean that you've had to read the whole book or take a test on it to be able to say I've read the book, or I've quoted something from the book that meant something to you. So don't cheat yourself out of it. Go ahead and experiment.Stuart Webb 11:12 I love that I am a real fan of the idea of skim, skimming, taking pieces. Because you're right, you can take one or two paragraphs. And they can be the thing which you can take from from a chapter or from a section of a book. And you can really get the sense of the book. Yeah, it is it but it's still the time to take and read that which I think is important because too many people are waiting for the film to come out so that they can avoid the hard work of having to do some, some thinking, you know, take the time to sort of think about some of this stuff. I think it's important thing, isn't it? And that allows you to to centre it and get it properly embedded in your own experience.Dr Troy Hall 11:50 Yeah, absolutely. And Audible is another good opportunity as well. Absolutely.Stuart Webb 11:54 Absolutely. So that gives me my final question, Dr. Troy. And this is what I always call my Get Out of Jail Free card. So I've asked you some questions. I'm sure there's one question that you're thinking I do wish he'd asked me. And now here's your opportunity. What is the question you think I should have asked you? And don't leave us in suspense? answer that question for us as well.Dr Troy Hall 12:13 Well, I think you should have asked me What is something that is not on my resume, so that I can share information with people that they can't get when they go to LinkedIn or they go to my website like that one. So you What are you going to ask me,Stuart Webb 12:28 I want you to answer it. Now. You know, what is this piece of information that's not on LinkedIn that we're going to find fascinating?Dr Troy Hall 12:36 Well, I've had this very unique opportunity. I've travelled to 45 of the US states, six over 60 countries and six continents. I've had the opportunity to kiss the Blarney Stone, thinking of course, that when I kissed the Blarney Stone, I would lose all the Blarney that I had. But my wife assures me that is not a problem. I'm still okay. I've been chased by an albino peacock. When I was travelling in some of the country land of France. I have shopped a water mall in a boat where you don't even get out of the boat that was in Thailand, written an elephant, a camel and a hot air balloon.Stuart Webb 13:14 Wow, what an experience. Those are. And I can I can tell you having written the camel, it is not it's not a comfortable ride, is it?Dr Troy Hall 13:22 No, it's really not. So I'll just tell you, you know, there's something about the one hump. Yeah, right.Stuart Webb 13:29 Absolutely brilliant. Dosatron, it has been a really fascinating insight into your work. Thank you so much for spending a few minutes with us. Really appreciate you doing this. I'm just going to switch banners briefly now and tell you that if you would like to find yourself listening to really interesting people like delta try. If you get onto our newsletter mailing list, we send out a mailing probably on the Monday or the Friday before each one of these recordings, letting you know who's on so that you can watch live if necessary, even ask questions of the of the guests we're talking to so you can get some first hand knowledge and people like Dr. Dre. Don't try. It's been a brilliant, brilliant interview. I'm so grateful for you coming on and spending some time with us. Thank you so much. Appreciate all you've said. And I'm going to be going and sort of getting a copy of your book now. And making sure that that's on the next reading this that's a cohesion culture by Dr. Troy Hall. You're we won't be on your reading list. Thank you so much indeed. You're welcome. Thank you very much. Get full access to It's Not Rocket Science! at thecompleteapproach.substack.com/subscribe

Today's Podcast Wednesday offering is Theology on the Go, where Jonathan and James welcomenot just any old theologianbut an Adonis! That's Dr. Adonis Vidu, author and associate professor of theology at Gordon-Conwell Seminary. His latest book describes the Trinity and, more specifically, the doctrine of inseparable operations. Unfortunately, the Church has begun to view the Father, Son, and Spirit as three distinct beings, each with a different mission. The doctrine communicates the correct view of God as one in three Persons, operating in inseparable unity. Why is a correct view of the Trinity essential for the Church? How might an incorrect understanding of the triune Godhead affect our understanding of His divinity? Hear why Christ has always been about His Father's work! To support this ministry financially, visit: https://www.oneplace.com/donate/581/29

Today Jonathan and James welcome—not just any old theologian—but an Adonis! That's Dr. Adonis Vidu, author and associate professor of theology at Gordon-Conwell Seminary. His latest book describes the Trinity and, more specifically, the doctrine of inseparable operations. Unfortunately, the Church has begun to view the Father, Son, and Spirit as three distinct beings, each with a different mission. The doctrine communicates the correct view of God as one in three Persons, operating in inseparable unity.   Why is a correct view of the Trinity essential for the Church? How might an incorrect understanding of the triune Godhead affect our understanding of His divinity? Hear why Christ has always been about His Father's work!   We have a few copies of The Same God Who Works All Things: Inseparable Operations in Trinitarian Theology to give away, courtesy of Eerdmans Publishing. Register to win yours!  

Authentic Conversations of Guts, Grit, and Gusto. That's Dr. Erica Miller's life motto.Authentic Conversations of Guts, Grit, and Gusto. That's Dr. Erica Miller's life motto.And her life has been a dynamic one. Dr. Miller was born in Tshernovitz, Romania, and when she was seven, Erica and her family were among thousands of Jews herded into cattle cars and imprisoned in a Nazi holding camp in Mogilev, Ukraine. After four years of indescribable oppression and deprivation, Erica, her parents, and her sister were liberated by the Russians. Her family emigrated to Israel in 1949, when she was 15. Erica attended high school at night while working during the day. Since education was not a priority at that time, receiving her high school diploma was an uncommon accomplishment. In 1970, Erica returned to school. Eight years later, she graduated with a Ph.D. in clinical psychology. Today, in addition to public speaking, Dr. Miller oversees her family's real estate business in Austin, Texas. She's written three books, “The Dr. Erica Miller Story: From Trauma to Triumph,” “Don't Tell Me I Can't Do It: Living Audaciously in the Here and Now” and the international best-seller, “Chronologically Gifted: Aging with Gusto!”Dr. Miller has always considered herself a citizen of the world. She travels extensively and pushes the envelope everywhere she goes. In June 2018, she climbed to the 17,000 ft. base camp at Mt. Everest, and in August 2018, she skydived in New Zealand. Her international adventures with family and friends continue to demonstrate how her passion for life fuels her endless drive to achieve and live life to its fullest.Today, our Erica is solo again, and talks with Dr. Miller about resiliency, living life to the fullest, and more in this optimistic and uplifting conversation.

Diabetes on TV and in movies is rarely anything close to accurate. Turns out, those media misconceptions can be real-life harmful. This week, Stacey is joined by Dr. Heather Walker, the co-author of (Un)Doing Diabetes: Representation, Disability, Culture and Dr. Phyllisa Deroze, who contributed a chapter called “Laughing to Keep From Dying: Black Americans with Diabetes in Sitcoms and Comedies. Dr. Deroze & Dr. Walker both live with type 1 and both have difficult diagnosis stories that influenced their experiences with diabetes going forward. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. More about Dr. Phyllisa Deroze More about Dr. Heather Walker ---- Check out Stacey's book: The World's Worst Diabetes Mom! Join the Diabetes Connections Facebook Group! Sign up for our newsletter here ----- Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners! ----- Get the App and listen to Diabetes Connections wherever you go! Click here for iPhone      Click here for Android Episode Transcription: Stacey Simms  0:00 Diabetes Connections is brought to you by Dexcom. Take control of your diabetes and live life to the fullest with Dexcom. This is Diabetes Connections with Stacey Simms. This week, diabetes on TV and in the movies is rarely anything close to accurate. And those media misconceptions can be real life harmful. Here's one from the sitcom 30 Rock.   Dr. Phyllisa Deroze  0:30 Tracy has diabetes there. And he does this skit where he replaces his foot with a skate. And he's like I'm practicing for when I lose my foot to diabetes. And that is the thing. There was a diabetes diagnosis and the next scene, he's already imagining himself with an amputation.   Stacey Simms  0:49 That's Dr. Phyllisa Deroze, who wrote a chapter in a new book we're talking about this week. The book is called (Un)Doing Diabetes Representation, Disability Culture. And it's authored by Dr. Heather Walker, Dr. Deroze and Dr. Walker both live with type one, and they join me for a great conversation. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Welcome to another week of the show, I am always so glad to have you here. You know, we aim to educate and inspire about diabetes with a focus on people who use insulin. This is our first show of 2022. So Happy New Year, everybody. I hope you're doing okay. Still stressful days for everybody. But hopefully you can kind of come along with me every week, as we talk about what we're finding interesting in the diabetes community. And I say that because 2021, I decided I was going to focus on technology for the year, I was going to try to do as many episodes as I could, talking about new technology talking to these companies. And I did that although I gotta say the log jam at the FDA made that a little difficult, right? I mean, we thought we'd have a lot more new technology. And a lot of companies will not talk about stuff until it is FDA approved. So this year, I'm going to stay with that because the technology episodes are what you have told me you are the most interested in, in fingers crossed are going to have some approvals pretty soon. But I gotta tell you, I've also decided that I'm going to do shows on just whatever the heck I find interesting. I started this show seven years ago, this coming summer, and honestly, this might be the last year of it in this form. I mean, I love it. I love doing this but seven years is a long time for any project. I have some new things that I'm working on. I'm not sure how much time all of it is going to take. I'm not abandoning the podcast by any means. I want to hear from you too. As we go forward. You know, as the year goes by, I will keep the lines of communication open. We will figure it out together. This episode does fall into the category of something I am fascinated by and I love to talk about and that is diabetes in media. And by the way separately. Both of my guests this week have bananas misdiagnosis stories, we get to that right out of the gate. Wait till you hear what one of their doctors ended up doing. I have never heard this happening before. It was pretty wild. And we will talk about the book I mentioned that it is (Un)Doing Diabetes Representation, Disability Culture. It is authored by Dr. Heather Walker and Dr. Dr. Bianca C. Frazer. It contains essays by other authors including Dr. Phyllisa Deroze a little bit more about the book in its public description. It says undoing diabetes is the first collection of essays to use disability studies to explore representations of diabetes across a wide range of mediums from Twitter to TV and film to theater fiction, fan fiction, fashion and more. In undoing diabetes Authors deconstruct assumptions the public commonly holds while writers doing diabetes present counter narratives community members create to represent themselves. And just a little bit more about my guests. Dr. Heather Walker is Associate Director of qualitative research at the University of Utah health. She was diagnosed with type one at age 11 in 2001, and Dr. Phyllisa Deroze began blogging at diagnosed not defeated almost immediately after being misdiagnosed. She found out later with type two diabetes in 2011. And now she has been correctly diagnosed with LADA. Dr. Phyllisa Deroze is also the founder of Black diabetic info after the interview, and it's a pretty long interview. And that's okay. They have a lot of great stuff to say, I'm going to come back I want to tell you about something that happened to me. It's not quite diabetes in media, but it is diabetes jokes. So I want to tell you how I handled something in a Facebook group. But I'll come back and do that after the interview.   Dr. Phyllisa Deroze, Dr. Heather Walker, welcome. I'm so happy to talk to you both. Thanks for coming on.   Unknown Speaker  4:50 Thank you.   Stacey Simms  4:51 So let's start if we could, I mean there's so much to get to and I was so excited to see you both at friends for life and see the presentations that you were doing but which You mind kind of backing up a little bit and kind of letting people get to know you? We could start just tell me a little bit about your diabetes diagnosis story. And Phyllisa, let me let me ask you to start with that if I could.   Dr. Phyllisa Deroze  5:12 Um, yes, I was diagnosed shortly after getting my PhD in English literature. I had moved to North Carolina, I experienced the classic symptoms of hyperglycemia. I had seen a physician who didn't check my blood sugar told me that I just needed to drink Gatorade because my electrolytes were off. A little later I was in the hospital. Blood sugar didn't register. Finally, I think first reading was like 597, or something like that. So I was told I had diabetes, and what type didn't get clarified until I was discharged. When I was discharged. I was told that I had type two diabetes, and I lived with that diagnosis for eight long years, it was inaccurate, I was misdiagnosed. I live with latent autoimmune diabetes in adults. And I was correctly diagnosed and joined the T1D group in 2019. I get this   Stacey Simms  6:06 question. Every time I speak to somebody like yourself who was misdiagnosed like that it happens so often. How do you live with what is really type one for all that time? I mean, I can't imagine you felt very well.   Dr. Phyllisa Deroze  6:20 I did. Okay, after diagnosis, I had a pretty long honeymoon phase, I actually lived about three years with just diet and exercise. I think one thing in the T1D community is that we don't talk enough about honeymoon phases and people who have latent autoimmune diabetes and adults, because so much of the common knowledge about type 1 diabetes is that everyone is insulin dependent. And that's not necessarily true, everyone will become insulin dependent. And that's an important message, because I never thought to have test done until I went into DKA. Again, so I myself didn't know that it was possible to have type 1 diabetes have a long honeymoon period and be misdiagnosed.   Stacey Simms  7:09 Yeah. The more I learned about Lada, it is so similar, but it's so different. There's a lot more to it, I guess, is what I would say, than I had realized for sure. Heather, what is your diagnosis story? When were you diagnosed with diabetes?   Dr. Heather Walker  7:21 So I was diagnosed at 11. And I also sort of have a misdiagnosis story. So I had diabetes, and I was in what I assumed to be a honeymoon phase for three months before my diagnosis actually came around. Because I was seeing a physician at the time who looked at me, skinny white girl, whose parents were really afraid because she kept losing weight, who was just about to hit puberty, and he thought eating disorder. No matter how many times I told him, I was eating everything in sight and drinking everything in sight. That's still what he firmly believed. Luckily, at about three months after I started coming in to see him for this and for the symptoms, he went on vacation, and I got to see his pa instead. And his pa John, you know, it's so funny. I don't even remember his last name. But just he's just warmly John to me, right? He just looked at my chart, and he knew right away, it's like, oh, you have diabetes, you know, so calmly, and I remember that freaking me and my mom out. We were in the appointment. It actually was my dad. But still, the first thing that we did was went and got me a doughnut because I think my dad was like, alright, well, maybe this is it. You know, he'll never eat another doughnut. Yeah, like, we really don't know about this, we don't know what's gonna happen. And so they didn't do a glucose tests on me. They just drew blood. So we didn't know right away anyway. And then it was like, you know, the next day, they called and said, You need to come to the hospital and for US history.   Stacey Simms  8:45 I'm guess I'm gonna get ahead of myself a little bit here. I don't want to start drawing conclusions too early in this interview. But it is interesting how both of you were misdiagnosed. Somebody else made an assumption, because of how you present it to them. I've got to imagine. So Heather, let me ask you. And then Phyllisa, I want to ask you the same question. But other how has that stuck with you? I mean, you you kind of set it so matter of factly they're like, Hey, he assumed I had an eating disorder. Did you kind of carry that with you?   Dr. Heather Walker  9:11 Oh, yeah, absolutely. I think I got a huge chip on my shoulder. From that. I mean, there's something about you know, being 11. And being in a world that already doesn't take you seriously, and then have a life threatening disease thrown at you. And your doctor doesn't believe what you say, even before diabetes. And Stacy, I've heard on episodes of your podcast you talking with with teens about or people who were teens with diabetes, about how fast it speeds your life up, right? Like you don't really get to have a childhood you don't really get to be a teenager and like, you know, carry on with reckless abandon because you just can't because there's all these safety things that you need to take into account. And so, but even before diabetes, I was kind of like that, like I was, you know, a 30 year old and a 10 year old body. I've been the same Age since then until now, but that, for sure gave me a big chip on my shoulder. It made me want to like, look into everything and see as it's happening to other people is like what's going on with this diabetes stuff.   Stacey Simms  10:13 Phyllisa, I'm curious for your experience too, because as you you kind of already said something interesting, which was like, Well, I didn't know how were you supposed to know? Right? The doctor supposed to know.   Dr. Phyllisa Deroze  10:23 Right. What's interesting is that when I was told that I needed to look into LADA because I had given a speech in Dubai to a roomful of doctors from the MENA region, Middle East and North Africa. And I was simply telling them my diagnosis story, very similar to what I share with you is a little more in depth, but pretty much that was the basics. And you know, I'm 31 years old at the time. And so during the q&a, some of the physicians from Tunisia, they raised their hand, and I was like, yes, they were like, well, your story kind of sounds more like LADA than type two. Are you familiar with it? And I said, not really. I mean, I know Cherise Shockley has it, but I don't know any more details than that. And it was at the lunch afterwards, one of the physicians came up to me and she said, you really ought to look into seeing if you have a ladder, and don't stop until you get the answer. And that kind of haunted me like, don't stop until you get the answer. But I just thought it was a simple request. So I asked my Endo, I got told no, I asked three months later, if I had ever been tested, the answer was no. Well, can I get tested? No. I saw a second opinion. No, you have type two. So I definitely think their view of me being an African American woman living with obesity played a lot into the constant denials. It took me over a year, another decay episode, and begging my gynecologist to run type one antibody testing for me in order to get it. So it wasn't easy. I literally had to not stop until I get the answer.   Dr. Heather Walker  12:11 For Phyllisa, it was your OB they finally gave you the testing you wanted?   Dr. Phyllisa Deroze  12:15 Yes. Because I told her, I can't get an endocrinologist to run this test. I know I'm in decay, a I'm losing weight rapidly. And she listened to me and she said, Okay, she said, I don't do endocrine, I do you know, OB GYN. So we were literally on her computer on Google trying to find the codes to request the testing. And so she was calling around, what do I put in to order this? And I remember when she called and she said, Listen, you know, this is out of my field. But come get these results, because your endo was going to need to see them. That was all on me. I got the results. I just remember seeing the get 65 should be below five. And mine was greater than 7500.   Stacey Simms  13:05 Oh, I'm almost speechless. I mean, I'm not I'm never actually speechless. I came in less than that happened. But the idea that you have to work so hard to get those answers, I've got to assume just like with Heather, that had to inform not only your experiences going forward, but the way you help other people because you both are extremely active in the community. You You're both very prolific writers, you both have, you know, studies and presentations that we're going to talk to, but Felicity, that whole experience with somebody else saying, Well, I think you have lotta to I got to get answers for myself to finally getting them. When you look back on that, how does it inform how you talk to other people about   Dr. Phyllisa Deroze  13:43 diabetes? I tell people definitely to be way more assertive than then imagined. Like, I honestly did not think it would take me constantly asking for the results. I thought it was like a simple test. I mean, you're testing my cholesterol, you're testing my a one C, like you're already getting a vial of blood, like just check off one antibody. So I thought it was something simple. And it turned out it was not, which was very frustrating for me. Because like in that I realized my education level didn't matter to them. I was literally like you are African American living with obesity. And that was what I believed to be their motivating factor to deny me testing. And what's so problematic about that, in addition to everything else you can imagine is as my physician Wouldn't they want to know that they're treating the right condition. Yeah, I'm asking so my records actually have a note from my endo saying, Melissa asked multiple times for type one antibody testing, and I denied it   Stacey Simms  14:55 literally says I denied it in your file.   Dr. Phyllisa Deroze  14:57 Yes. Wow.   Stacey Simms  14:59 I'm just sorry. I got to ask, did he show that to you as an apology? Or did you sit there in the room while you made him write it?   Dr. Phyllisa Deroze  15:05 What I did was I refused to leave the appointment. I love it until there was this moment of record, like, I need you to recognize that I have been asking you for over a year for this test. We just need to come to that because it was like, Oh, you need insulin, let's go. And, you know, I was kind of being escorted out of the room. And I said, No, I'm literally not going to leave this chair until we have this conversation. And so I didn't know that my endo would put it on my records. But I definitely refused to leave until that conversation was had, they did apologize. And there was a note and my files.   Stacey Simms  15:47 It just didn't have to be that hard. This could have been an episode in and of itself. Want to make sure to get to that the research or the publications that sparked my interest here.   Right back to our conversation and right was like kidding about the diagnosis stories, and then her doctor putting in her chart that he was wrong. Oh my god. Alright, Diabetes Connections is brought to you by Dexcom. I want to talk for a minute about control IQ, the Dexcom G6 Tandem pump software program. When it comes to Benny's numbers, you know, I hardly expect perfection, I really just want him happy and healthy. And I have to say control IQ, the software from Dexcom. And Tandem has completely exceeded my expectations, Benny is able to do less checking and bolusing. And he is spending more time in range. This is in a teenager, a time when I was really prepared for him to be struggling, his sleep is better to this is great for all of us basal adjustments possible every five minutes, the system is working hard to keep him in range. And that means we hear far fewer Dexcom alerts, which means everybody is sleeping better. I am so grateful for this, of course Individual results may vary. To learn more, go to diabetes connections.com and click on the Dexcom logo. Now back to the interview. And we are moving on to Dr. Walker's book. Heather, tell me about the book that's coming out.   Dr. Heather Walker  17:14 Okay, I'm so excited to be talking about this. So you might hear that excitement in my voice. So it's awesome. The title of the book is called undoing diabetes representation, disability culture, that's a full title. And it's going to be released very soon, by the end of the year, we hope it's a collection of essays that looks at diabetes in a new way, the volume or the volume as a whole. You know, it points out that all the stereotypes of diabetes that the public really buys into are like maintained through a lens of individualism, our society looks at diabetes as a problem of the individual person right of their choices. And so to respond to that public tendency, right to like focus on the individual, all of our authors in the book do the opposite. So in the collection, they ask questions like, What do individualistic stereotypes reveal about the social conditions for the diabetic person? So it like flips it on its head? And also what do they conceal, right? What is stereotypes hide? What do they prevent us from seeing? And how do these like harmful narratives, these harmful assumptions, these stereotypes that just break down our community? How do they reinforce ideas that the public already has, for what constitutes like a normal or a good body, which is just like, as a person who's living with diabetes, this makes me so excited. And then I'll just add one final thing about the book, which is our collection is really unique in that we use disability studies frameworks to unpack all of these questions. What are disability studies? So this ability studies is a field of study that looks at the social conditions of disability. So how is disability perceived in society? How is it represented on the screen, and all of those types of things. And so we have frameworks in the field that we use, it's kind of imagined, like a camera lens, right? That's kind of like a framework and the camera lens has a filter on it. And so when we look at this movie, or this film, we're looking at it through a specific lens with a specific filter. In our book, all of our authors are looking at different types of media, through these disability studies, frames or lenses, and sort of seeing how they operate in society and what they do, and then poking holes at what it does. And every chapter is brilliant, and Phyllisa is going to talk about hers, but as a volume, like I could not be more proud of this collection and all the work that it does. And all of like the change and the shifts it's going to make for readers.   Stacey Simms  19:43 It's so interesting to me because of the mediums that you use so let's let's ask Felicity if you want to if you could talk about what you presented friends for life, what you talked about you were looking at TV shows, right and not unfortunately not more current ones which sometimes get it right.   Dr. Phyllisa Deroze  19:59 Um, yeah, I was the title of my chapter is laughing to keep from dying black Americans with diabetes in sitcoms and comedies. So I was looking at television shows as well as movies, and focusing on how those representations make meaning of diabetes within African American communities. Part of this started, when I thought about the first time I heard you have diabetes, and I was in the emergency room, my first thought was, I'm going to die. Like that. Was it? Like, I just thought like diabetes meant death? And when I started unpacking that, to find out where did I get that messaging from? Because no one in my family has diabetes. I didn't personally know anybody with diabetes. It really came from television and film, and of course, our media. And I thought it would be really nice to look at some of these classic movies and TV shows that are very popular in African American communities to see what story is told when you focus on the diabetes characters. Can you talk about some examples? Yeah. So for example, like Soul Food is one of those classic staple in African American film, a memory just like the color purple is something that people cite quotes from all the time. But when you look at Soul Food, it really stems from Big Mama who has diabetes. We understand this because she burns her arm on a stove. And a couple of things later, she passes away, she has an amputation and then a stroke. And she's no longer with us. The Big Mama character also comes up in Tyler Perry's plays and his films in his television shows. And again, these are staple matriarch characters who have diabetes. Now Madea lives on because that's a part of, you know, Tyler Perry series, but she has diabetes Boondocks I look at and of course Blackish. So blackish, I would say is probably where we first see the the image turn, where we first see a character with diabetes, checking their blood sugar, and all the other stuff we don't. And so what that tells us is that diabetes is going to cause either a slow death or quick death, perhaps an amputation, if you're familiar with 30, Rock. Tracy has diabetes there. And he does this skit where he replaces his foot with a skate. And he's like I'm practicing for when I lose my foot to diabetes. And that is the thing, there was a diabetes diagnosis, and the next thing, he's already imagining himself with an amputation. So when we look   Stacey Simms  22:59 at something like this, what do we take from it now? I mean, we you can't go back and change those representations. What do you want us to kind of learn from them.   Dr. Phyllisa Deroze  23:08 But I would ideally like for the film industry, to change their portrayal of characters with diabetes, I mean, all characters, not just African American ones. But last year, there was the release of the Clark Sisters first ladies of gospel biopic on lifetime. The Clark Sisters are like a staple in African American culture. They were these gospel singers that were absolutely phenomenal. The Lifetime movie of them ended up being the highest rated Lifetime movie and four years. This comes out last year, the mother has diabetes. She is seen not taking her medication, not caring about her diabetes. And of course, there's all these tragedies that happen. And the thing is, when we don't see African Americans using CGM technology, insulin pump technology, we don't see checking blood sugar. What happens with those messages is that it becomes the common assumption. So when someone goes to the doctor, the doctor may think, Oh, well, black people don't check their blood sugar. And so then that begins to impact the individual prime example. I was in a setting once. And a woman said, Oh, I didn't think black people ate vegetables. What? Yes, yes, literally said this. And I was just so floored, but I thought, okay, she didn't think black people ate vegetables. And so I'm wondering like, what images you know, is she being fed? Right? Yeah. came from so the thing is, is we have to look at our television and our film, not just as sources of enjoyment for some people, but also as information that provides an understanding about certain people. So literally in all of the films and television shows that I look that there were probably two that showed the African American character with diabetes, actually living a rather fruitful life. Outside of that it was amputation and death. And so when someone is diagnosed with diabetes, like I was, and I didn't know anyone with diabetes, instantly, the first thing I thought about was death and dying. And that association that comes with it, when I hadn't seen people living well, with diabetes, I just want to say this. When I was first diagnosed, I went to Barnes and Nobles sat down in a bookstore with one of Patti LaBelle cookbooks, and I flipped to a page and she said, in this book, I had diabetes, but I wasn't going to let diabetes have in me, and I cried, right there in the Barnes and Noble, because that was the first time that I had ever seen or read or heard someone who looks like me diagnosed with diabetes, and they were determined to continue living their life. Like if you want to see that image, where do you go? Because our television and our films are not that place. And that's also the fertile ground for which black diabetic info on my website started and my blog, because I didn't know where to go for that. Like, I got it in Patti LaBelle cookbook, and I cry. But then where can I go to see it again? Yeah, didn't have an answer. Heather, I   Stacey Simms  26:53 want to come back to you and ask you something I saw you posted about on on Twitter. A couple of months ago, Pixar posted a teaser for their new movie turning red, which I think comes out in the spring. And there's like a split second shot of a kid wearing some kind of what looks like diabetes device. It's, you know, an insulin pump or a CGM. And they confirmed it. I actually talked to somebody behind the scenes at Pixar and fingers crossed, we'll have them on the show in a couple of weeks. But it is a diabetes. I'm so excited. But it is a diabetes device. But you were pretty adamant about one point, would you mind sharing that? And why? Sure.   Dr. Heather Walker  27:30 So when I saw that, you know, I came late to the show. Let me preface with that, right. Like, by the time I saw that trailer, the community was abuzz. Like they everyone was so excited. And what I saw was, Oh, my goodness, we see a character with type 1 diabetes. And as someone who is completing a chapter for a book of essays on representations of diabetes, you know, my antenna went up when I saw how the community was claiming that. And I just thought to myself, This is not a representation of type 1 diabetes, this is a representation of diabetes, because people with type two can and should have access to those devices as well. And so for the type one community to be exclusive, in this moment, in this grand opportunity for all of us to celebrate together, really sort of broke me down in a way, you know, I was like, Why? Why can't we just keep this open? Why can't we make this a win for everyone? Instead of saying, quote, unquote, type two people don't use these devices? And I think that the reason why it was like it was like a jab in my heart is I think that that claiming does something in society, right? It, it functions to show us that large groups of the diabetes are the type one community feel like, maybe type two diabetics aren't using that technology, because they're the ones who don't care. And they're the ones that the stereotype is about. And so that shows me that we have pockets in our type one community that buy into the stereotype just like the public does.   Stacey Simms  29:06 I'm looking at the description of the book in terms of the different mediums you use Twitter, to TV to film to theater to fiction, fan fiction.   Dr. Heather Walker  29:13 Yeah, we have a chapter, whatever author of your chapter covering a segment of fan fiction, and it's wonderful and actually, that author and she discloses in her chapter as well, so I'm not outing her. She also lives with diabetes herself. And I'm pretty sure she has a physical science PhD. So this genre and this discipline is new for her and she just like, Oh, she did such a great job having us understand how diabetes is being pulled into fanfiction. Alright, we   Stacey Simms  29:46 now should have set this up better if you're not familiar, and I'm going to do probably a terrible job of describing this. If you're not familiar. Fanfiction is stories, poems, pictures, it's fiction, written by people who are Fans have a genre or fans of a certain bunch of characters, and then they kind of make up their own stories using the established characters most of the time. So in other words, you love Harry Potter, you write yourself into Harry Potter or you write a different adventures that the characters might have had. And it's accessible to pretty much everybody. Is that how I feel about fanfiction? Yeah, I   Dr. Heather Walker  30:18 think it's kind of a, you know, once you get into it, you know where to look. You can probably Google it. And you know, I'm not even really in the world of fanfic, full disclosure and transparency. But I feel like I want to beat now that I've read, I've read that chapter. So   Stacey Simms  30:34 these are characters people are writing about that loop with diabetes, or they are the just bringing diabetes into exactly as it sounds. It sounds silly, as I'm saying it out loud. Like I'm explaining it. I'm trying to, you know, hit it over the head to the to find a point. But just to be clear,   Dr. Heather Walker  30:48 yes. So I think in the pieces that this author talks about in their chapter, it's situations where the characters themselves do not have diabetes, and the fanfic authors write them having diabetes. Oh, so they add that to their character.   Stacey Simms  31:04 You know what we were doing that a long time ago? Because I don't know if you know, Heather, and Phyllisa, but Bob, the builder definitely has diabetes, because why else? Would he have that big belt around his equipment? Because that's where his insulin. So anytime we saw somebody on screen with that, he was like, Oh, he's got diabetes. I didn't mean to interrupt Heather. But that clarifies it for me.   Dr. Heather Walker  31:23 Oh, yeah. That's a perfect example. Right is imagine that we had a fanfic author who loves Bob the Builder when they were a kid. And now they're writing the whole story about Bob, the builder and his diabetic life. It's wonderful. The book itself,   Stacey Simms  31:37 is this something that's accessible to people? And I asked that I mean, is it more of an academic book, tell me a little bit more about that.   Dr. Phyllisa Deroze  31:43 So one of the things that I like about the book is that it's assessable. For a large reading audience, if you are a casual reader, you can get through it, if you are an academic, you can get through it. So it's not laced with academic jargon. But again, we are using theoretical frameworks, but in a language that is accessible to everybody. So that's one I definitely enjoy about the collection, is there something in there forever?   Stacey Simms  32:13 And that's a great point, because I think we do get a little nervous about academic type books, Heather, right. I mean, it's, it can be a little scary and off putting it away.   Dr. Heather Walker  32:21 Yeah. And I'll just add, you know, we have, so we have several authors who are like myself, and Phyllisa, who are scholars and community members, which is very nice, and just like really brings it home. And so, you know, you kind of know, as a community member, that you're going to get authentic pieces by people who are living with this, in addition to having a couple of us who are scholars and committee members, we do have chapters from community members, from activists who don't have their hand in academia at all, and they're writing about their personal experiences. And, you know, they're still talking about representation in different media, but they're doing so from their lens existing in the community existing in the world with diabetes. And if nothing else, although I, I would also say what, you know, Melissa said was true, all of them are accessible, but especially those that are coming, you know, from the mouths of babes that are coming from our community members, who, who many people who do pick up the book already know,   Stacey Simms  33:20 before I let you go, let me let me pose this question to each of you in kind of a different way. And that would be you know, full. So you mentioned blackish, being a bit of a turning point, the show where people are shown, you know, a character shown checking blood sugar. I'm looking back over the last year and thinking of a more accurate depiction of diabetes, or at least type one with the Babysitter's Club on Netflix with we'll see with Pixar is turning red, but with Greenland, you know, written by someone who's married to Greenland, the movie Written by someone who is married to a person with type one, do you think things are getting better? And and I would ask you, as well to include the black community, because we don't talk about that enough. You know, I mean, I'm trying to think if all of those I mentioned they did not feature people of color. Do you think it's getting better? I mean, what would you like to   Dr. Phyllisa Deroze  34:06 see, I would like to see more diversity as we get better in the American film industry. When I look at all the films that I studied, type 1 diabetes is grossly under represented like none of these characters have type 1 diabetes, which again, if you think about myself, 31 years old, being diagnosed, I never knew type 1 diabetes could be an option. I'm still not seeing African American characters using technology wearing CGM. Often when I'm out in public. People are asking me about my devices. It's the first time you're seeing them. I'm explaining insulin pumps. And so while things are getting better, I would say within shows, television shows and films that are popular within African American characters. Progress is about Very slow on that. And   Stacey Simms  35:01 Heather, from where you stand. Could you share a little bit about what you think is going on in media? Are we getting better?   Dr. Heather Walker  35:07 Yeah, I think Phyllisa what you're speaking to right is incremental ism. It's like we are getting better slowly, like painfully, slowly, bit by bit. I mean, I'm inclined to say yes, only because the number of representations that we're seeing are increasing. But, you know, I'm hesitant at the same time to say yes, because we still have to ask, okay, if we even if we have more representation, are they representations that are doing good for diabetic people in society? Right, like, not necessarily, Are they accurate? Or are they you know, a direct portrayal of what people experience? But what is the public taking away from that representation? Like, what are they leaving that with? And if we have a lot more characters all of a sudden who have diabetes, but the audience still thinks, Okay, well, diabetes is still what I thought it was, right? It's like overweight people over eating, making bad choices not exercising? If that's what they're leaving with, then the answer, of course, is no, we're not making progress, even if we're having more characters. And what I find is, what I think we would need to make really big change would be to centralize a character with diabetes instead of making them a sub character, right? Yeah, like for the baby sitters club. And Stacey is not a new character with diabetes is has old, right, like we've known that Stacey has had diabetes for a long time, it just wasn't being produced at the quality it's being produced at. So that's not really even a new one. But we do have new ones, like there's a just a year and a half ago, or so there was a new series called Sweet magnolias. And one of the characters there has, or is about to be diagnosed with diabetes, and it's the same, it's the same story. It's like, you know, if you don't fix your habits, you're gonna get diabetes, and you're gonna die like your mom and all these fear tactics. And so and I really want to be hopeful, Stacy, I really want to be hopeful and say, Yes, we're headed in the right direction. But I just don't know i We need people in the writers room with diabetes, and other health conditions and disabilities, to have a direct voice and call things out before they're produced.   Dr. Phyllisa Deroze  37:19 I agree 100%, we have to be in the room. Because some things they don't make sense. For example, blackish, you do see him check his blood sugar. However, once he puts the strip in the meter, he starts talking to his wife, and anyone who knows how to use a meter knows that you have about 30 seconds before you have to put a drop of blood on that thing, or else you've lost it. So even little things like that.   Stacey Simms  37:46 I had indicated that was the last question, but I got one more. And that would be and II feel free. Either one of you jump in? Or both? What can the community do? You know, sometimes I feel like, you know, I stopped correcting people online a lot of the time unless it's really egregious, you know, but if they make a joke, or there's a hashtag diabetes with dessert, or things like that, like I'm tired, you know, and then you have no sense of humor, you know, gosh, what can we do to try to fix this? Or what can we do to to improve the situation?   Dr. Phyllisa Deroze  38:15 I think, this research, this book, this podcast, these conversations are so important. So for example, prior to writing my book chapter, I didn't see anything talking about the representation of African American characters in television and film. Whenever I talked about diabetes characters, there was maybe the one mention of soul food, but like, there was a dearth there. So this book chapter hopefully helped spark the conversation in wider circles. And so by talking about it more, and rallying around these things, hopefully, the attention like first recognizing that there is a problem, and then getting think tanks together to talk about them is probably the best plan of action.   Dr. Heather Walker  39:06 I love that. And I would just add, you know, I think what the community needs to prioritize is inclusion, right? Like, we need to give up on being exclusive, especially in the type one community, and we need to open our doors to people with type two people with Ladda. People with all like, there are so many different types of diabetes, that even saying type one and two is, is exclusive. I really believe that if we can do that, and if we can elevate the voices of people with diabetes of all types, who are also people of color, then we'll make a lot of progress in our community because we'll start seeing those perspectives that we've been missing that make us as a community really limited to our own perspective. To me, that's the only way to do it. I love the idea of a think tank Phyllisa I think that's brilliant, and just absolutely, and I'm sure you would agree needs to be diverse, right? Like it can't Be a bunch of like, white people. I don't know. There's a lot we can do. There's a lot.   Stacey Simms  40:08 Thank you both so much for joining me. This is amazing. I'm so thrilled to have you both on the show, you've got to come back on there. We just kind of scratched the surface here. So thank you for spending so much time with me.   Dr. Phyllisa Deroze  40:18 It's a pleasure. Thank you for having me.   Dr. Heather Walker  40:21 Yeah, this has been so fun. You're listening to Diabetes Connections with Stacey Simms.   Stacey Simms  40:34 More information about my guests and about the book on diabetes all at diabetes connections.com. As you know, every episode has its own homepage with transcriptions and show notes and all that good stuff. The transcription started in January of 2020. And we're working our way back here in there, hopefully filling in all the blanks. But right now, not every episode before 2020 has a transcription. And I should tell you just I don't want to get ahead of myself here. That Pixar movie that we talked about turning red. Since our conversation, they put out another trailer and it showed more diabetes gear, another child in the movie is wearing a Dexcom. So it looks to me I mean, really can't tell yet. But it looks to me like one kiddo has some kind of pump. And another kiddo has a Dexcom. So as I said, I had a contact at Pixar. And I've got another one now. And it looks like there might be an actor, a voice actor in the movie who has diabetes. So we're to sort this all out. And I should be able to have somebody on about this. I don't want to over promise. But the folks at Pixar have been really receptive. So that looks like they won't do it too far in advance because the movie comes out in March. So as we get closer, I'll keep you posted for it. And I had mentioned a story before the interview about not necessarily diabetes in media, but about jokes. And I don't know about you, but years ago, I was on high alert for diabetes jokes, you know, I can't eat that, or the the hashtag of my dessert is diabetes. And I don't know, I got burned out. And I don't talk about it as much. I don't police it as much, certainly, but I couldn't help myself last week, at Christmas, I'm in a group. It's a very clever group. It's called fatten the curve. If you want to join it. It's a public group, a friend of mine in the Charlotte area started at the very beginning of COVID. Obviously, it's a play on flatten the curve. And as you would expect fatten the curve is all about food. And it's just become a place where people who cook and eat like to share their photos. And somebody posted around Christmas time, you know, it's my diabetic coma, and then all of this food. So I kind of did the do I want to go to I want to do this, or I want to get this person's face. So I just very nicely said, Hey, diabetes jokes are never cool. Not sure if you thought about that. But hey, the food looks absolutely delicious. You know, hope it was as good as it looked or something nice like that very casual and breezy. Just like Hey, dude, not cool. But moving on. And there's a couple of other people in the diabetes community who have joined that group, but it's not diabetes, it's just food. But you know how it is when when Facebook shows you something people, you know, jump in. So other people commented like, yeah, Stacey's right? Please think twice. And this guy apparently lives with type two posted like a non sequitur about his scientific studies and stem cells and all this stuff about diabetes. He did, obviously, not really sunk in I don't think, but he didn't respond negatively. And I just said, You know what, fine, I'm moving on, right? But then a couple of days later, somebody else popped in, it was like, nobody can make a joke anymore. You're too sensitive, and why we're just too easily offended. And that's when I was like, Alright, now I need to respond. So I very nicely, I think it was nice. You know, I wrote a response. And I said, Hey, you know, once the guy said he had diabetes, you'll notice I didn't clap back, I didn't get nasty. We are all entitled to say whatever we want. But it's important to understand that what we say does have meaning and impact. And as you listen, I know, you know, all this, I did the standard. When we joke about diabetes, we don't do this with other conditions. We don't talk about a cholesterol coma, or a high blood pressure problem when we're eating big meals like this. Why is it only diabetes? And did you realize that actually, you know, the blame and shame that can be encountered here prevents people from seeking treatment or makes them feel like it's all their fault, and nothing they do will matter. I posted all that waiting for the response. There was none, which I'm really glad about. Because I don't want to argue I just it's exhausting. But everyone's not something like that pushes my buttons and I have to save something. Hopefully that group will just go back to posting yummy pictures of food because it's been two years and we haven't had any issues like that. I mostly post pictures of what my husband cooks. Because I don't like to cook and what I do cook isn't really Facebook, really. So I guess we're often running for 2022. We are back to the Wednesday in the news episodes. I hope you'll join me for that either live on Facebook, YouTube or Instagram, or as an audio podcast which comes out on Fridays. Thanks as always to my editor John Bukenas from audio editing solutions. Thank you so much for listening. I'm Stacey Simms. I'll see you back here soon, in a Couple of days until then, be kind to yourself   Benny  45:07 Diabetes Connections is a production of Stacey Simms media. All rights reserved. All wrongs avenged

When we heard about a new seven day infusion set approved this past summer, we had a lot of questions! We've been told since the very first day of pumping to only use the inset for 3 days tops and to always rotate the site. How did they get seven days out of one of these without skin irritation and with good absorption? We asked the folks who make the inset to come on the show and explain. Turns out, ConvaTec Infusion Care makes the insets for Medtronic, Tandem, Ypsomed, Dana RS and Roche pumps. So while I started off talking about the longer-wear version, the conversation you'll hear includes everything from proper insertion technique, their challenges teaching users best practices, improvements they're making to the cannula and more. In this interview you will hear: John M Lindskog, President & COO, Matthias Heschel, Vice President, Research & Development and Intellectual Property Rights and Dr. Kerem Ozer, Director Infusion Care Clinical Development Good article about using insets correctly and understanding the different types. Check out Stacey's book: The World's Worst Diabetes Mom! Join the Diabetes Connections Facebook Group! Sign up for our newsletter here ----- Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners! ----- Get the App and listen to Diabetes Connections wherever you go! Click here for iPhone      Click here for Android Episode Transcription Below:  Stacey Simms  0:00 Diabetes Connections is brought to you by Dario Health manage your blood glucose levels, increase your possibilities by Gvoke Hypopen, the first premixed auto injector for very low blood sugar, and by Dexcom take control of your diabetes and live life to the fullest with Dexcom. This is Diabetes Connections with Stacey Simms. This week, how much have you thought about the way your insulin pump connects to your body? Honestly, it's where a lot can go wrong. The people who make the insets know that they have come a long way. And they're trying to make it better.   Matthias Heschel  0:40 It's what some people call their Achilles heel in the arm therapy were very much aware of it. And our approach simply is instead of doing product design at the drawing board, to the product design in the field, really taking the patient at the core of our design process, really understanding behaviors, understanding what could go wrong, and then design the product accordingly.   Stacey Simms  1:05 That's Dr. Matthias Heschel, head of R&D for ConvaTec infusion care. He, the CEO and the Medical Director sat down with me to talk about longer were tips for users and what's next for this really important part of pumping. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Welcome to another week of the show, you're always so glad to have you here. We aim to educate and inspire about diabetes with a focus on those who use insulin. I am really excited and happy to talk to the guys from ConvaTec. This week, you know, they were frank, they were really up for anything. And I have said for years that insets are the weak link in pumping. And they really opened my eyes to some of the issues and what we can do as users or you know, as parents of users to make things a little bit better. And of course, they're working on improvements as well. But before we jump in a little bit of housekeeping, I want to talk about the rest of the year schedule for the podcast, I can't believe we're in well into December at this point. Right now the plan is to keep going with these longer format. The interview shows that air on Tuesdays, and we'll have that there shouldn't really be any interruption or any week skipped through the rest of the year and into January. I'll let you know if that changes. But that is the plan right now. As for the newscast, I will probably not have a newscast on the 22nd of December. Again, I reserve the right to jump in and make a liar out of myself. There is breaking news sometimes late December is when the FDA makes a lot of decisions. So we could have some breaking news. But I would say right now, it looks like at least that one date will not have the live newscast on Wednesday on Facebook, Instagram and YouTube. And so then I will not be turning it into one because that would be a podcast on Christmas Eve and I don't think there's a lot of demand for you to listen on Christmas Eve but you tell me if there is I'm happy to serve and try to put all that together. Another quick announcement and I'm actually going to talk more about this after the interview is that book number two is in the works. The second World's Worst diabetes mom, I signed on the dotted line to deliver that next year. So we have a timetable. We have a theme. I have lots of stuff. I'll tell you about that again after the interview, but man, I'm really excited about it. Alright, a little bit more about our guests. ConvaTec infusion care makes insets for both of the tubed pumps available in the US they make for Tandem they make for Medtronic, they don't make Omni pods. They also make insets for Ypsomed and other tubed pumps abroad. But if you use a tubed pump in the US you use their products. In this interview you will hear John Lindskog The President and CEO, Dr. Matthias Heschel, the head of R&D, research and development and Dr. Kerem Ozer, the Medical Director, I worry a bit about three voices. I mean, really, it's for with mine, but we do I think we do make it clear. And there is always a transcript over at diabetes connections.com at the episode homepage, if you find it easier to you know some people follow along, reading as they listen. Some people prefer to read my transcription software. Let me tell you got a workout on this one. It doesn't speak diabetes very well to begin with. And as you can imagine, there was a lot of technical stuff but we did it we got it and it's there for you. But I think that these three were very frank and gave us a lot of information a national here. They have a question for us. That's coming right up but first Diabetes Connections is brought to you by Dario health. Bottom line you need a plan of action with diabetes. And we've been lucky that Benny's endo has helped us with that and that he understands the plan has to change. As Benny gets older you want that kind of support. So take your diabetes management to the next level with Dario health. Their published studies demonstrate high impact results for active users like improved in range percentage within three months reduction of a one C within three months and a 58% decrease in occurrences of severe hypoglycemic events. Try Dario's diabetes success plan and make a difference in your Diabetes management, go to my dario.com forward slash diabetes dash connections for more proven results and for information about the plan. John, Matthias and Kerem, thank you so much for joining me. We have a lot to talk about. And I feel like I've ever been to the company at my disposal. Thank you so much for taking the time to do this.   John Lindskog  5:20 Thank you, Stacey. This is John and thanks for having this opportunity to talk with you. Maybe just a couple of words of ConvaTec infusion care. I'm the president and CEO of that part of ConvaTec. We are based out of Denmark and out of Mexico, we have one plant making a few sets in Denmark, and we have two plants almost side to side in Mexico, and also is fully dedicated to making few sets for subcutaneous infusion. Today with me, I have the Matthias and I Kerem and if you could just kind of introduce yourself briefly.   Matthias Heschel  5:58 Yeah, this is Matthias. I'm heading research and development at ConvaTec Infusion Care. I've been with the company for 10 years. Just happy to be here.   Dr. Kerem Ozer  6:07 Hi, everyone. I'm Kerem Moser and I'm the medical director for ConvaTec infusion care. I'm an endocrinologist by background. I've been with ConvaTec for about four months now. And prior to that I was in practice seeing endocrinology and diabetes patients for about 15 years, and very excited to be here.   Stacey Simms  6:28 Wonderful. Well, thank you all so much for joining me. We have a lot of questions, questions for my listeners questions that I have as a mom of a kid who has used insets since he was two years old. So let me jump in and ask about the newest infusion set as I see it, which is with Medtronic and Matthias. Let me ask you about this if I could. we're hearing really interesting things seven day up to seven day wear, which I believe rolled out in Europe first is now approved in the United States. How I don't want to ask you to give any trade secrets away. But how do you get it to last so long when we've been told for years that two to three days is the maximum for an infusion set?   Matthias Heschel  7:03 Yeah, actually, the answer is very simple. Stacey. Medtronic, they provided quite some details about the year back at the virtual conference. So Medtronic, they added a proprietary connector, which connects the tubing to the pump reservoir. And this connector stabilizes the instrument. On top of the canula, a new tubing, which contains the preservatives, contains the antimicrobial effect of the preservatives. And the last thing is that we added a new adhesive to keep the infusion set on the body for up to seven days. So basically three things. New connector, new tubing, containing preservatives and a new adhesive.   Stacey Simms  7:48 So it was kind of a partnership with Medtronic. It's not all on the inset itself.   Matthias Heschel  7:52 It's a partnership with Medtronic, and they in general, talking about new product development, future products. It's all at system level. So we cannot just develop a new infusion set. We need to take the reservoir into account we need to take algorithms into account so it's it's always a close partnership with pump manufacturers.   Stacey Simms  8:15 how have people received it? Or is it working well, is the adhesive doing okay, on people's skin?   Matthias Heschel  8:20 It seems so we have received some first indication Medtronic percent that results at the diabetes technology meeting here this week, actually. And that has shown that there are lower occurrence of hyperglycemic events. There are fewer occlusions. And I think the average wear time was seven days. So it seems that the patients that have come on to an extended wear infusion set are really happy and the infusion sets perform as designed.   Stacey Simms  8:57 Before I move on from this one more question for you Mateus if I could. I'm curious, are you working with other pump companies on longer where infusion sets? Or is this going to be a Medtronic exclusive for the foreseeable future?   Matthias Heschel  9:10 Well, extending the wear time of infusion sets, that's the unmet need, number one among all patients, so and that's in general interest from all pump manufacturers to have extended wear products in the portfolio. So yes, we're working on the portfolio of infusion sets.   Stacey Simms  9:30 Kerem, let me move over to you if I could for this question. As a parent of a child with type one. We were schooled early on the importance of rotating sites, right? You can't let an infusion set go in the same part of the body over and over again. But most kids and frankly most adults I've talked to who use these products do kind of have a favorite spot. The body. Can you talk a little bit about Yes, I guess there the importance of rotating, but something like a seven day wear or what's coming in the future. Is there a possibility that it could be a little less important? to move that around, or am I dreaming?   Dr. Kerem Ozer  10:02 That's a really good question, Stacey sort of looking forward, just taking a quick step back, just like you said, the importance of sort of proper rotation is something we always talk about in clinic yet in real life, we know that people have their favorite sites. And part of the idea of the rotation, of course, is to reduce scarring and is to reduce lipohypertrophy. I know your listeners will be very familiar with this. But of course, when we say lipohypertrophy, we're talking about sort of the hardening that bumpiness of the layer right under the skin, that subcutaneous area. And when I think about lipohypertrophy, there are several factors that increase that risk, you know, multiple daily injections, pumps, continuous glucose monitors, sometimes the type of insulin being used, and that really changes from person to person reusing pen, needles, all those factors, even higher insulin doses tend to cause more of a higher risk, higher diabetes, duration is a higher risk. Now, when I think about those factors, some of them are you can't change those like diabetes, duration. Some of those factors, you can change by rotating things, when you look at something like extended wear, I think one advantage is you are going to need to change it out less often. So you're technically changing it, you know, less often, it's probably best practice to still change the site and rotate the site. But one thing I think that's going to be even clearer, and I see this all the time, you know, when I talk with my patients, is, I think it's going to be important to realize subtle changes in the characteristics of that site, even before you start feeling hardening of the skin, even before one starts feeling that bumpiness if you notice that a site is starting to not respond as well, you know, you're feeling that you're needing more insulin, you're feeling that the dynamics are changing. That's I think, when it's going to be really key to make that site change.   Stacey Simms  12:21 Interesting. I have kind of said, it's a little bit flippant, but I've said since we started pumping, 14 and a half years ago that gosh, these insets are the weak link in pumping. And what I mean by that is they can fall off easier, they can get occluded, they only last a couple of days. John, maybe let me ask you, can you talk us through a little bit about how you're really trying to make these better? Because I feel like I can have the greatest algorithm in the world on my pump and if the darn thing is flapping on my kids off my kids stomach it's not gonna work   right back to our conversation. Yeah, he does answer that question. But first Diabetes Connections is brought to you by Gvoke Hypopen. You know low blood sugar feels horrible. You can get shaky and sweaty or even feel like you are going to pass out – there are lots of symptoms and they can be different for everyone. I'm so glad we have a different option to treat very low blood sugar: Gvoke HypoPen. It's the first autoinjector to treat very low blood sugar. Gvoke HypoPen is premixed and ready to go, with no visible needle. Before Gvoke, people needed to go through a lot of steps to get glucagon treatments ready to be used. This made emergency situations even more challenging and stressful. This is so much better and I'm grateful we have it on hand! Find out more – go to diabetes dash connections dot com and click on the Gvoke logo. Gvoke shouldn't be used in patients with pheochromocytoma or insulinoma – visit gvoke glucagon dot com slash risk. Now back to John Lindskog answering my question about making the insets more foolproof.   John Lindskog  14:00 No, no, no, I totally understand what you're saying I will say and then maybe Matthias can chime in after this that, you know the products like insets, they go through a quite extensive and long development program before they actually come to the market and the products also available on basis on customer feedback. And since this is a medical device, it's very highly regulated in the US through the FDA requirements and Europe through CE and in many, many other countries through local legislation. So the level of rigor and preciseness that you have to do in this work is quite extensive for us to develop a product and mass make it into volumes, which we're talking about millions of units per year does require quite a bit of development work to go there. And there is a little bit of you know there's a lot of factors that play into to the to the development, particularly manufacturing of the infuser set, the quality has, of course, to be the highest possible within the requirements. And there's also, of course, a economical part of it, where you need the competitive cost in order to have these products on the market. So I mean, the process that you see today is actually a combination of all the the user input, and of course, also about, you know, the requirements from regulatory authorities. And, and you know, what can be made in very high scale, we, you know, and strive to improve the products along the way, however, even what may seem as being very small, and my new changes, does actually require a complete change process, which is very well documented, and in that sense, also kind of lengthy process. And I don't know Matthias. If you have any anything to add to that, yeah, quick   Matthias Heschel  15:56 Yeah, but I would like to add is that we have, we have about 1 million pump users worldwide. And as a create variability, it's both the interpatient variability and intra patient variability. So huge differences between patients and also huge differences between the use conditions during a day for the same patient. So what we are going after in our product design is really making as robust designs as as reasonably possible. And best example is, is the newest infusion set on the market, which is the base of the extended wear we talked about earlier, an infusion set we call Mio advance which virtually only has one user step. So you hit the bottom activation button and it produces the soft cannula, retracts the needle and detaches the serter all instantly. I mean, all the steps happening in a fraction of a second. And that means you're basically take the patient out of the equation, the patient cannot do any mistakes during the insertion process. And there we see a huge reduction in in failures on the market. So to your question, Stacey, I mean, we understand that the infusion set is the weakest link, it's what some people call the Achilles heel. In pump therapy, we are very much aware of it. And our approach simply is, instead of doing product design at the drawing board, to the product design, in the field, really taking the patient in the core of our design process, really understanding behaviors, understanding what could go wrong, and then design the product accordingly. And we have seen the first successes and they hope to see further successes.   Stacey Simms  17:40 You know, that's a great point about the very simple insertion of the Medtronic inset. Are there any plans to simplify more brands, because I'm thinking of the one we use for Tandem? And you know, by the time you open it, you peel off the sticky stuff, you, you cock it, you get it ready? You know, sometimes you're already set for error, because if the paper writes up the needle, you know, there's all sorts of different things that can happen if people either press too hard or do it at a weird angle. I know you know this, I don't have to spell it out for you. But are there plans to simplify other insets in the way that you just described? Since you've seen how successful it is?   Matthias Heschel  18:16 yeah, plans to incremental improvements on existing infusion sets, based on the learnings we have from the field, among others, what we touched upon removing the paper liner from the adhesive, we can certainly redesign this to make it easier for the patient. And that's, that's definitely on our agenda.   Stacey Simms  18:37 I have a bunch of questions that I got from my listeners, they were really interested that we were talking so let me go ahead and grab those. The first one here was really interesting to me. This listener wants to know about the faster acting Fiasp insulin, which seems to have a little bit of difficulty in some pumps, I was wondering if you were looking into that for different faster acting insulins that the manufacturers are coming out with and if you're testing those and working on ways to improve that in the insets   Matthias Heschel  19:06 Yeah, maybe keep a close eye on the market. And every time a new insulin is approved for pumps, therapy, we add this onto our list and do all the necessary trucks stability testing, device stability testing, so you can put this onto our indication for the infusion sets and then it's up to the to the pump manufacturer to also indicate the pump for the new insulin and then the patient can use it. So and that also applies to Fiasp. So we have done all the necessary homework and we know that at least a couple of the pump manufacturers are considering to broaden their pump indication to also include the Fiasp   Dr. Kerem Ozer  19:47 And to that I may also add that we're also going to be looking at Lyumjev ultra rapid lispro insulin from Lilly, which as you know is also approved just recently for pump use. So That will also go through the same processes that Matthias mentioned, whether it's working on biocompatibility, looking at what the system does to the insulin, and its excipients and what the insulin is excipients do to the pump. And so that's in the works as well.   Stacey Simms  20:15 I meant to ask earlier, I had heard about something I don't know if this is the in-house name or something that you're using and research called Lantern technology. Could you explain what that is what you all are working on?   Matthias Heschel  20:27 I was hoping you would ask this question. Lantern is a pretty simple feature tries to mitigate the occlusions we sometimes see for soft cannula infusion sets, when the soft cannula is bent or kinked. And the Lantern features are actually pretty simple. So we provide the soft cannula with additional slits close to the tip of the cannula, and in case the soft cannula experiences any physical impact is spent or even kinked then those slits would open up and would allow to the inset to continue to flow. So it's basically a measure to mitigate the risk that a cannula on the infusion set can get occluded in the cannula.   Stacey Simms  21:15 That sounds really interesting. It sounds like didn't BD medical a few years ago have something that sounded it sounded at least to my ear similar that it had the different slits in the cannula? And it never came out? Is this similar technology.   Matthias Heschel  21:29 It's you could see it as it's different as a similar technology. It's though, quite quite different. I mean, they provided an additional exit hole, just one hole close to the tip of the cannula. And that actually weakened the cannula significantly, and the product was out on the market. They call it a smart flow technology. And the product was marketed by Medtronic as a process that was withdrawn from the market right after. And with our long term technology, putting a number of slits, we have really avoiding this issue that the cannula really occludes. Imagine if you just have one side hole and the cannula kinks or bends, and you would close up this hole. And in our case, having four or six slits, that would be always a couple of slits open and allow the Insulet to flow. So it's a different technology.   Stacey Simms  22:25 Yeah sure. And I don't know how much you can share which brands might get that? In other words, are you working with Medtronic on this? Or you're working with Tandem on this as somebody else? You know, in the should we be watching for this in a more proprietary form? Or will it just going to go in all of your insets?   Matthias Heschel  22:40 Right now we're in the process of implementing technology in our mainstream products, which are the inset two products, which are available to all pump manufacturers, and then we need to see pump manufacturers will pick up on this.   Stacey Simms  22:56 Got it. Kerem, let me ask you if I could, do you have any best practices for your patients when it comes to using the insets and infusion sets? Are there mistakes that are very common that people make, I'd love to kind of hear, you know, what you what you tell your own or in the past what you've told your own patients?   Dr. Kerem Ozer  23:13 Absolutely. The key things, especially if someone is very new to living with diabetes, as you know, there's there's a lot of anxiety there. Everything is new, a lot of new information is coming in, you know, at our clinic, what I always tried to do, what we always tried to do was sort of taking a deep breath, letting people know that there's a lot of resources, there's a lot of support, you know, at the risk of sort of repeating the cliche, it's not a sprint, it's a marathon, and really providing the resources, sort of focusing that more on to the infusion set side, I think one key thing is starting, especially if someone's new to pump therapy, sitting down with them going over the whole process, we had demo kits, sometimes I would demonstrate sets on myself even just to make sure that everyone's feeling comfortable, especially for our younger patients, having the parents there and really taking the time to walk them through the process of what an ideal insertion looks like. And I think doing it in real life really helps in person in real time. As opposed to watching a video which where everything looks so perfect, right? So we definitely emphasize that prioritize that. And then when we start thinking about using the sets, a lot of those things using the alcohol pad and cleaning the area, a lot of things that are repeated, easy to say hard to do every single time. But I think emphasizing the fact that the closer and closer we get to that ideal that the longer we can keep the site's healthy, the longer we can keep the process healthy is important. And as more technology comes in as continuous glucose monitoring gets integrated. As the pumps get smarter, I think there's always the importance of that of that person factor. And making sure that we're really addressing everyone as an individual and sort of seeing where they are and going and holding their hand and walking with them to where they need to be or where they want to be, is key. And then there is as you know, a lot of variation from person to person. And there's a lot of variation from day to day. And being aware of that repeating that message. And sometimes you wake up and you have a perfect day. And sometimes you wake up and there's a lot of obstacles and changes and bringing that message that, yes, diabetes is there. Yes, it brings challenges. But if we see it as part of a larger system, and if we address it as well as we can, as if we can stick with those guidelines, and recommendations. And if we keep open lines of communication between the patient and the family and the clinic, things tend to fall into place. And I'm very proud to say your many, many patients, of course, live decades and decades of healthy lives with diabetes. And I think that the key component there is keeping those lines of communication open and keeping that sort of positive attitude going.   Stacey Simms  26:38 Alright, let's get back to some of the questions that my listeners had. And I thought this was a really interesting one, she asked me when insets are designed is any consideration given to those of us who deal with limited hand strength, or older adults with smaller hands, or even using color tubing to increase the visibility of air bubbles or maybe using color in the cannula. So it'd be easier to see if it was correctly inserted. I've got to believe that you look at this and you do research it but Matthias, can I ask you to just hop in an answer that one?   Matthias Heschel  27:07 Sure. Well, every time when we design a new product, we put a lot of effort into the initial conceptual work. And that means that you propose certain designs, which we then show to the target population. And if the target indication of the product is smaller children or elderly people, those will be included in the assessment of the concept. So we really trying to already in the concept phase to design the product in the way that we can make sure that it can be used by the by the target population. And at the same time, we are compliant with standards. For example, when we have a product that requires activation to push a button, what's the strength of a point of finger for a for a small girl? so we were really trying to incorporate this in our product design.   Stacey Simms  28:05 Another question came in there used to be an infusion set by a different company called an Orbit. I don't recall this, but this sounds great. It rotated so the tubing was less likely to get caught. Any plans to bring that back or something similar.   Matthias Heschel  28:18 Well Orbit is owned by another company Ypsomed in Switzerland, and to our knowledge, the product is still on the market. So we don't have any insights in the in the details. But it's not it's not one of our products.   Stacey Simms  28:35 Got it? It's probably something that's not available in the US yet because we don't have Ypsomed here yet. But it's it's supposed to be coming. Okay, I have a very might be a silly question, but I will ask it anyway, this is a silly question. I get it from listeners all the time. One of the first times I remember getting our box of inserters we had the old one I always describe it looks like a little spaceship. I mean, I know you know exactly what I'm talking about for it was the Animas way back when and now we use Tandem, it came with these little plastic pieces, and no one ever told me what they were for. And as it turns out, then we realize this after my son's inset got filled with sand at the beach, and we could not reconnect. It turns out these little pieces are supposed to go in and protect the site and keep sand out. But I've heard a lot of different versions of what they are really supposed to do and when you are supposed to wear them. So my question is, when you put an inset on the body, it was explained to me like it's almost as though you've got like a vial of insulin with a little rubber on top. You can pierce it, but you can't get into it. In other words, you don't have to cover it every single time you take a shower or go in a pool because nothing is seeping through until you reconnect the needle. Is that the proper use of those inserters   John Lindskog  29:50 Yeah, this is uh, John maybe just a quick comment. So that that is that is true that at the at the time development there were some spare caps. And the idea here was that when you disconnect the tubing from the side, it's true that you know it sealed, the side doesn't seal because there are septums that closes the fluid pathway. However, the idea about providing these small inserts was that you could protect kind of the surface of the septum. With that kind of cover so that you wouldn't have any kind of larger particles being able to, to come in the way like the listener just described getting sand in it. So it was actually, you know, kind of a protection. However, it was not something which was necessary, it was kind of, you know, choice you could make to add that in, though. So that the reason behind that   Stacey Simms  30:48 perfect, there just seems to be a little bit of a misunderstanding in some parts of the community, what people think it keeps bacteria from getting, in other words, if you swim in a lake or something like that, you should pop it in. But it really is just to keep out particles like sand.   John Lindskog  31:01 Yeah, it's only for larger particles. And, you know, the site is perfectly sealed as it is. So it's it's more to kind of say, Okay, I want to make sure that that, you know, I don't have to clean it up afterwards, and so on. So that was the rationale behind that.   Stacey Simms  31:18 I have one or two more questions, kind of to wrap it up. Have I missed anything in particular that you guys wanted to make sure to bring up before I start wrapping up?   John Lindskog  31:26 Actually, there was just one question that I think that at least I had, I would be curious to know about, you know, in each box of the insets, there is an instructions for use, how you deploy, the infusion set.  What's out and, you know, that is in some countries made in a number of different languages and so on. And I guess I'm just curious about is that being read all the time, or is that you know, being kept in the place or simply just, you know, put it into the trash can. But what's kind of, because I have a I have an assumption. We have an assumption, what happens to these but but I was just curious to know, if you could share that with us.   Stacey Simms  32:07 I'm so excited that you asked that question, John, I think you know the answer, I can't imagine anyone is really reading the instructions, we all should. In fact, I'm going to take those instructions out and look through them. But it's one of those situations where my book that comes with each box is so thick and intimidating. As I'm telling you this, I'm thinking this is why I don't do it, maybe it's just I'll have to take a look at how long the actual instructions are. Maybe it's in several languages. And that's why it's so thick, but we're so used to and maybe we can blame the iPhone for this. We're so used to opening something up and being able to use it immediately and hoping right that it's very intuitive, that maybe that's why we don't read the instructions. So there's a lot of user error. And frankly, I know there's a lot of user error within sets. I've seen it in my house, I've been the user making the error. So I'll ask my listeners, I mean, I'd be happy to take a quick poll in the Diabetes Connections Facebook group, but I do recall taking a pump class, and we were there for two hours, I came home a couple of days later, I had to change the inset on my two year old I had forgotten everything I had learned. And at the time, this was 2007. I found one video, I mean, think about the days of YouTube back in 2007. And it was in French to show me how to change the inset. But I did that rather than look for the instructions. So John, what a great question. And I will get you more feedback from the community on that.   John Lindskog  33:29 Okay, thanks. Thanks a lot. Thanks. I will say though, that, you know, it is a regulatory requirement that we put those in a box. And we would, you know, like to move it into some kind of, you know, YouTube media or something like that. However, the regulatory requirements are that they should always be there. So we want to see if we can move that in the regulatory requirements. So we can, you know, save some printed matter, and, you know, reduce the waste and make it easier to access.   Stacey Simms  34:02 It's a great point. That is a great point. Before I let you go, here in the United States and I assume in many parts of the world, there's a lot of concerns about supply right now. Any issues, any concerns anything people should be thinking about for the next couple of months?   John Lindskog  34:16 No, I you know, and we have had some issues on supplies in the beginning of the when COVID-19 was at the highest and we have been putting in extra capacity for making progress and investing large sums of money into getting you know, capacity brought up and we should be out of those weeds by the end of this year. And we don't really see any, any issues going forward. But you know, it may take some time to get that all through the supply chain, but I can assure you that we're doing everything which is now a power to always have the capacity to supply the what the demand is.   Stacey Simms  34:57 Let me as we wrap this up, Kerem, let me ask you this. You are new to the company, or you are the newest person here, so the company, what excites you and you know, you've worked with patients for a long time, you've seen how important this part of the device and system is, what excites you about this technology going forward?   Dr. Kerem Ozer  35:15 This is a great question. And this is the reason I'm, I'm here, I'm in the company, I think it really goes back to that point about realizing how important looking at patients insights, their experiences, where they are, what they need, and bring that feedback into the company to help develop new technologies. And I would say, a direct corollary to why I'm so excited about my role here is this is really sort of being a medical person, a physician, and endocrinologist and industry, you really play a bridge role. You're constantly talking with the engineers with the business side, and you're keeping your ear open to your patients, your community and your colleagues. And sort of you're part of that feedback loop, bringing back ideas, presenting your products and saying this will work. This is a great idea, and sort of keeping that momentum going. And I'm very excited about that.   Stacey Simms  36:20 Excellent Matthias you are in r&d, you are the head of r&d, you're in the I wouldn't say the trenches so much. But you're really seeing realistically what's happening on the company every day. Anything you want to add to that. I mean, is there anything that you're really excited about that you'd like to listeners to leave listeners with? Yeah,   Matthias Heschel  36:37 I mean, what, what I always tell the engineers is, you guys, you are directly responsible for how patients or people in the state beat is, how they feel how they are able to manage their daily life. If we do a great job, those people can lean back once in a while and perhaps even forget about the disease, if it will not do a perfect job. They have a terrible day. So that's, that's really what people understand. And that's why at least how I see it. I mean, those people in the medical device industry typically work longer work harder, because they understand they understand the responsibility they have.   Stacey Simms  37:17 Well, thank you so much all of you for spending so much time with me for answering our questions for posing your own questions, which doesn't happen that often. And I'm really glad that you did that. We will get you some answers. Thanks so much, gentlemen.   You're listening to Diabetes Connections with Stacey Simms. Lots more information at diabetes connections.com at the episode homepage, and I'll link to some of the studies they talked about that longer were the stuff that's in the works. And let me tell you, I went and got the book. I have it right here. Can you hear that? I'm wiggling it, I went and got the book that comes with the insets. And it's right there. Of course, at the top with the little horseshoe thingies that they explained. I hope they cleared up some stuff for you. The book is long, because as I said, it's in many other languages other than English, the directions are maybe two or three pages long. I think it's really just two pages. There's some pictures here. But the English instructions are one to three pages long. And then that's it. So Benny and I actually sat down and read them. And he does it slightly differently. But what he does works, I mean, we are 15 years into diabetes. So that means we were 14 and a half years into pumping. So he's got it down. But if you're having trouble, I may start a thread in the Facebook group. Because there's some really easy tips and techniques to make sure that you you put these insets on correctly in follow the directions. That's your best bet. But as you know, the community can help too. So we'll we'll put that in there. And of course, I'm going to put a poll up about the and we put I may have already done that by the time the episode airs, because a pull up about have you ever read the directions? I was a little embarrassed. You heard me laughing when he asked, but I'm glad he did. Alright, I've got some news coming up about next year. Oh my gosh. But first Diabetes Connections is brought to you by Dexcom. And when we first started with Dexcom, it was back in 2013. It was about this time here, the share and follow apps were not an option. They just hadn't come out with the technology yet. So trust me when I say using share and follow make a big difference. I think it's important though to talk to the person you're following or sharing with and get comfortable with how you want everyone to use the system. Even if you're following your young child. These are great conversations to have, you know what numbers will make you text, write how long you're going to wait to call that sort of thing. That way the whole system gives everyone real peace of mind. I'll tell you what I absolutely love about Dexcom share and that is helping Benny with any issues using the data from the whole day night. And not just one moment. Internet connectivity is required to access separate Dexcom follow up to learn more, go to diabetes connections.com and click on the Dexcom logo. A couple of weeks ago I told you I would have some book news and I do I am so excited to announce that the world's worst diabetes mom, part two is going to be out next year, I just signed on with my publisher. We talked this week, actually this morning, as I'm taping this episode, and we laid it all out, because my goodness, with some of the publishing issues, probably hopefully not the shipping issues by next year. But a lot of what's going out of the publishing industry, I have to have everything done earlier than I did last time to have the book Ready by a certain time of year I wanted out for as you can imagine, I wanted for November of next year, because Diabetes Awareness Month is my best bet to get any kind of, I guess, mainstream media attention on diabetes, media attention. And that worked really well. In 2019. When I put out the first book, the name of the book is not part two. I'm not sure what we're going to call it yet. But I will be sharing that with you all, I'm going to be sharing more of the process this time around, just as I think it'll be fun. And I'm going to be sharing things like cover options and title options in the Facebook group Diabetes Connections, the group. So if you'd like to help me the community was a huge help last time around in terms of how to word things. Because you know, when you're a parent of a child with type one, there are some differences that you want to be respectful about. There's some differences and ways of wording things that that just for clarity, right? A good example is are you a T one D parent, to me, that means a parent who lives with type one, right? So you have to It's little things like that you just have to be careful about and you will help me so much with that the first time around. So I will be asking the second time around, I have an idea for a title, I kind of know what the direction is going to be. I know what the title is going to be. I know what the focus is going to be on. We're going to be addressing a lot of the things that I have been asked about since the first one came out. So really excited, a little bit nervous. But man, I loved writing the first one. So I hope this will be as much fun to put together. All right, thank you so much to my editor John Buchenas from Audio Editing Solutions. We will be back on Wednesday. We are now live on Facebook and YouTube at 430. Eastern time. And then around 445 I'm live on Instagram. A little bit different for those of you who live on Instagram a lot like evolve. I mean, what a pain. Right? But it's fun. I like doing it. It's only a pain because I share photos. And I'm not that adept. Really. I mean, Instagram is not a friendly platform for sharing photos live and reading a script. Let me just tell you say if you've got advice on that, and you know how to do it, well, let me know. Or you could just listen to the audio podcast that comes out every Friday for in the news. Thank you so much for listening. I'm Stacey Simms. I'll see you back here soon Until then be kind to yourself.   Benny  42:35 Diabetes Connections is a production of Stacey Simms media. All rights reserved. All wrongs avenged

Johnathan More Starr Peak Mining Interview with Johnathan More CEO Starr Peak Mining #Gold #StarrPeakMining #JohnathanMore Hi, and welcome to the show! On today's My Future Business Show I have the pleasure of welcoming to the show, CEO and Chairman of Starr Peak Mining Jonathan More talking about Gold and other commodities, VMS deposits and the bright future that awaits Starr Peak Mining. Starr Peak Mining Stock Symbols (TSX-C: STE & US: STRPF) Johnathan has over 20 years of experience in North American and European capital markets focused on natural resource industries. He had a history of achievement from his years with Canaccord Capital. In August 2008, Johnathan retired from Canaccord Capital as an investment advisor to apply his experience and contacts to the public company sector. During the call, Johnathan shares how a company called Amex Exploration hit some big holes near the property owned by Starr Peak, which is not only the property right next door, but also the crown jewel of the region, the past-producing mine, where modern drilling has never been conducted and that's where the mother lode, the main vein, the source of the mineral riches, is believed to be located. Johnathan goes on to say that what's amazing is that Amex's stock has since already moved up by 700%, but Starr Peak has not even doubled yet, so it's like a second chance to participate in a mad gold rush that's still in its infancy. Thus, Starr Peak Mining is a company that's defying gravity right now and moving on its own merit, irrespective of market weakness or flatness. Starr Peak is fast becoming a big under-the-radar winner that has the potential to become a huge success story, even more so than it is right now. The crucial component of this story is that Starr Peak Mining have discovered something so rare that it is literally considered the holy grail of the mining world, since so few companies have ever discovered it. It has eluded the major players for a century: A VMS (Volcanogenic Massive Sulphide) deposit, with rock containing multiple base metals, including zinc, copper, silver, and gold! Starr Peak was after gold, but what it encountered on its first drill hole was much more. Because of the strong drilling results that Starr Peak has announced in recent months, an unprecedented collaboration has happened: right before Starr Peak announced its maiden drill results with evidence of a VMS discovery, the Chairman and founder of Amex was appointed as Starr Peak's Chief Technical Advisor. That's Dr. Jacques Trottier, PhD, a seasoned geologist, with experience on VMS-type deposits. The best place to find a huge gold deposit is right next to another mine, so it's critical to keep in mind that this was the original strategy of both Amex Exploration and Starr Peak was to purchase a project right next to the past-producing Normetal Mine. Contained within the property is Normétal, a mine that produced more than ten million tonnes of ore, containing gold, silver, copper and zinc, between 1926 and 1975. The mine was so productive that a town of the same name sprang up around it. For Starr Peak, this is like drilling in a treasure box. To learn more about Starr Peak Mining, or to contact Jonathan directly, click the link below. Disclosure of Material Connection: This is a “sponsored post.” The company who sponsored it compensated My Future Business via a cash payment, gift, or something else of value to produce it. My Future Business is disclosing this in accordance with the Federal Trade Commission's 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

The way we learn is no longer unilateral. So why act as if still one teacher, standing in front of a group of students lecturing them on a particular subject is the best way for them to learn a second language? Instead of teaching simple words or phrases such as bike, or car, what if the focus was on developing the skills that actually help people advance their careers? “The old way of teaching, where you teach the same thing to everybody — teacher in front of the room, using a textbook that gets purchased — no one thinks that's a good way of doing it. Good teachers actually go out and try to find supplemental materials that were interesting to their students. They look for news articles, or short stories, or something, but they can't take all that content and curate it and deliver it to learners. It's impossible for humans to do that. However, machines are really good at doing that. When I realized that was the very best way to teach learners, I decided to try to use computers for what technology can do best, to let people do what teachers do best.”That's Dr. Katie Nielson, who earned her PhD in the school of languages from the University of Maryland in 2013, where her research focused on technology-mediated language training. Katie has dedicated her career to making language learning more accessible and now, as the CEO and founder of Voxy EnGen, she's using technology to deliver high-quality needs-based instruction to immigrants and refugees.On this episode of IT Visionaries Katie, dives into why the way we teach language in the states is a broken process and how to fix it. She also explains how her platform is delivering personalized learning at scale to those that need it most. Enjoy!Main TakeawaysIf There's A Problem, Fix it: When you're developing a solution to a problem, you have to think about how your solution can be applied across different verticals. This means taking time to research the various options you have when it comes to getting your product to market, but also thinking about what your unique identifier is.A Barrier to Success: English is often what holds workers back from succeeding at their jobs. Instead of non-English speakers having to go to class in order to advance their linguistic skills, they should be able to do that on their own time with a program that teaches them the basics, but real-world scenarios based on their jobs to help them  improve.Setting a Baseline: When you're developing any kind of algorithm or personalized experience, the first thing you have to identify and establish is a baseline for your measurement. This is how you identify the areas where someone needs to grow, but it also can be used as a tool to identify how far a user has come with your program.---IT Visionaries is brought to you by the Salesforce Platform - the #1 cloud platform for digital transformation of every experience. Build connected experiences, empower every employee, and deliver continuous innovation - with the customer at the center of everything you do. Learn more at salesforce.com/platform

Anticipation just keeps growing for the new Omnipod system, still waiting for FDA approval. This week, we talk to Dr. Trang Ly, Senior Vice President & Medical Director at Insulet Corporation. We'll get an in-depth run through of the features of Omnipod 5 with Horizon, what makes it different from the other hybrid closed loops already on the market, and many other questions you all had. Our previous interview with Insulet CEO Shacey Petrovic  This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Check out Stacey's book: The World's Worst Diabetes Mom! Join the Diabetes Connections Facebook Group! Sign up for our newsletter here ----- Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners! ----- Get the App and listen to Diabetes Connections wherever you go! Click here for iPhone      Click here for Android Episode Transcription Below Stacey Simms  0:00 Diabetes Connections is brought to you by Dario health manage your blood glucose levels increase your possibilities by Gvoke Hypopen the first premixed auto injector for very low blood sugar, and by Dexcom take control of your diabetes and live life to the fullest with Dexcom.   Announcer  0:21 This is Diabetes Connections with Stacey Simms.   Stacey Simms  0:26 This week anticipation growing for the new Omnipod 5 system still waiting for FDA approval. Many of the people behind it have waited a long time to knowing the promise of closed loop systems for people with diabetes and their families.   Dr. Trang Ly  0:42 I still remember the very first time the very first patient that I put the system on and, and I was watching that insulin being delivered. And I remember just like hugging the participants, Mom, because we just both knew how incredible this was going to be if, if this could reach masses of people.   Stacey Simms  1:04 That's Dr. Trang Ly, Senior Vice President and medical director at insulin Corporation, we'll get an in depth run through of the features of Omnipod 5 with horizon. What makes it different from the other hybrid closed loops already on the market and many other questions you all sent in. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Welcome to another week of the show. You know I'm always so glad to have you here. We aim to educate and inspire about diabetes with a focus on people who use insulin. As you listen to this particular episode couple of things to keep in mind, Omnipod 5 with Horizon the full name of the system we are talking about today is not out yet it is not commercially available as of this taping. This episode is live on August 3 2021. The FDA is still mulling it over. If you are looking for even more information and some of the history of this, it may be worth going back to our first episode about this system that was almost exactly two years ago with the company CEO Shacey Petrovic. And I will link that interview up in the show notes at Diabetes connections.com COVID, really through this submission for a loop with the delays. And I didn't mean upon there with the word loop. But I know there has been frustration in the community. And there's frustration with an Insulet as well. But it really is close. Now, if you are not familiar and I know we have a lot of new listeners who've joined the show more recently. I know some of you have been hearing about this for years. But bear with me for just a moment as I explain it very quickly. You've got your Omnipod pod. That's the thing that holds and infuses the insulin, it's an all in one. It sits on the body, there's no buttons, there's no display, there's nothing to read, you've got your separate handheld controller, the thing with the display on it and the buttons are the touchscreen of how you actually control the pod when it comes to giving insulin for meals or for correction doses, that sort of thing. And for Omnipod five with horizon, you also have the Dexcom G6, the continuous glucose monitor, the pod and the CGM work together to give less or give more insulin to try to keep you in range. Now that is very, very simple. But Dr. Ly will explain it in much better detail. And I will also link up more information as always in the show notes. If you haven't ever seen what this looks like if you're curious, we'll link you up to all of the information. Dr. Trang Ly, my guest is the Senior Vice President and medical director at Insulet. Corporation, she leads their Omnipod five automated insulin delivery system clinical program before her time at Insulet. Dr. Ly was a pediatric endocrinologist in Australia. And toward the end of the interview, we talk about how personally knowing families that will benefit from this system and systems like it, you know what that is like for her. So my interview with Dr. Ly in just a moment, but first Diabetes Connections is brought to you buy Daario health and over the years, I finally managed diabetes better when we're thinking less about all the stuff of diabetes tasks, and that's why I love partnering with people who take the load off on things like ordering supplies, so I can really focus on Benny, the Dario diabetes success plan is all about you all the strips and lancets you need delivered to your door, one on one coaching so you can meet your milestones, weekly insights into your trends with suggestions on how to succeed get the diabetes management plan that works with you and for you, Dario is published Studies demonstrate high impact clinical results, find out more go to my dario.com forward slash diabetes dash connections. Dr. Ly, thank you so much for spending some time with me. My listeners are very excited to get all the information that they can about this. So thanks for being with me today.   Dr. Trang Ly  4:58 Yeah, great to be program. Thanks, Stacey   Stacey Simms  5:01 you got it. Let's start with an overview. I know that most people listening are probably very familiar with what we think Omnipod 5 with horizon will be. But can you start by just giving us an update and taking us through what is in front of the FDA for approval as you and I are speaking today?   Dr. Trang Ly  5:17 Yeah, so happy to do so the Omnipod five system that you're referring to is Omnipod, or Insulet, first automated insulin delivery system. So this system, he has previously known as horizon or the Omnipod, five algorithm on the pod itself. And it talks directly with the ICGM, which is the Dexcom G6 sensor, and also has a separate controller device as well to be able to remotely deliver boluses and stop and start automated mode, the system that some kind of FDA just requires you to wear a pod and a CGM to stay in automated delivery, because the algorithm is on the pod itself. And I think that is the key feature of the Omnipod five system,   Stacey Simms  6:14 a lot to break down there. And we'll get to each of the components. But let's start there with the kind of the brains of the operation being on the pod. What does that mean, in a practical sense when someone is wearing the system that they don't have to worry about it stopping that sort of thing?   Dr. Trang Ly  6:27 Yeah. So the The key difference between previous products is that with our current Omnipod dash and earlier versions of Omnipod, the pod delivers the basil programs and the bolus delivery that the user has initiated. And so insulin is not under automated delivery. But in our future system with Omnipod. Five watch the pod does is that takes the CGM value which you wear on body and so that value directly communicate with the pod itself. And then the system and the algorithm on the pod takes that CGM value and determines how much insulin you need every five minutes. If you're running high, and you need a little bit more influence, the pod will automatically increase insulin delivery. And if you're at your target or dropping low, it will augment insulin delivery, so it might suspend or it might reduce the insulin that you need. That is the key difference between the product that is available today. And the future with Omnipod. Five,   Stacey Simms  7:38 you would still use the PDM or the phone and we'll get to that to give yourself a meal bolus or a correction bolus.   Dr. Trang Ly  7:47 That's right. For those instances where you're about to have a meal. Or if you're running high for whatever reason, like you underestimated carbs earlier, and you want to give a manual bolus, you can do that any time. And you would do that by using the controller device or PDM, to enter in your carbs, and use our bolus calculator to deliver that insulin. So all of those features are very similar to the current production on the pod dash, which again, is very similar to our earlier version. So that's on the pod.   Stacey Simms  8:24 Let's talk about the algorithm a little bit. I know there's a lot that's proprietary here. But I'm curious, we've seen over the last couple of years, Medtronic come out with a you know, an automated device. Tandem has control IQ, I believe my listeners are pretty familiar with the workings of those, what would be the biggest differences between how those systems work and how Omnipod 5 with horizon will work.   Dr. Trang Ly  8:49 I'm very familiar with those algorithms. Because I, you know, in my previous life, I worked very quickly with those systems as they were being developed. And so I say, you know, having been in this role for the last five years and been running the clinical trials. For them, I can tell you that the main difference I'd say would be that our algorithm, you can set the target glucose for whatever time of day. And the range we have is between 110 to 150, in 10 milligram per deciliter increments. And you might have a family where you want to go overnight, you want to run out and 20 because you feel more comfortable at 120 overnight, and then but during the day you want to run at 110 you can set up a profile so that the algorithm augments insulin delivery to your preferred target glucose level. And, you know, we we knew when we were coming to market that we were not going we certainly weren't the first and not the second product market. So we knew that we had to deliver a level of personalization for our users. So we really listened to what people wanted. And people do want that level of personalization and customization. And so we implemented that design feature into our clinical trial to demonstrate that our system performs very safely across those different target glucose level. Until our clinical studies which show we'll get into Dude, what was tested across a very wide range of patients, for initially, we did a beam study, which was for patients aged six to 70 years of age. And then most recently, just a couple weeks ago, we were reported on our preschool age participants who were between two to six years of age, and they see I'm sure you'll appreciate that they're young. glucose control is just very variable, very unpredictable. And, you know, I think strength of our algorithm is that it works very well, even if you, you know, Miss or skip a bolus, occasionally, you know, that algorithm is going to kick in, it's going to deliver, you know, a decent amount of insulin to get you back in range, it's going to happen immediately, but it's calling to do its best to keep you in the range as much as possible. And similar, I'd say to the other systems, especially, I'd say more second generation systems is that we are getting, you know, excellent timing range, especially in the overnight period.   Stacey Simms  11:32 It was I laughed a little when you said preschool, as you know, My son was diagnosed before he was two. And whenever I see studies with little kids that work so well, it's so exciting, because you know, that age group, they can't even tell you when they're feeling weird. They can't stomach my son couldn't even pronounce the word diabetes. So it's a different age group altogether. So I was thrilled to see those results.   Dr. Trang Ly  11:53 I know, well, I have two kids under five right now, and they don't have diabetes. And I have no idea how much they're going to ace or whether or not you know how much activity they're going to do. And I just can't even fathom how challenging it would be to have a child with diabetes. And are they low? Or are they or as I just grumpy? asleep,   Stacey Simms  12:18 I didn't have enough. Oh, my goodness, I should have said this towards the beginning. And I know, I know Dr. Like that, you know, this, we use control IQ. We're very happy with the Tandem, but we're not rooting for any system here. I think that the and I say we I mean me, I it's so exciting to see all of these systems beginning to come to market beginning to really have an impact to have differences in their algorithms so that people can pick and choose exactly what they want. And we're just at the beginning of it. So I am so excited to see the study's going so well, I have a couple of questions about what you've already mentioned, on that target of 110 to 150, just to be crystal clear about it, you're talking about not just putting the pump into say using Tandem, for example, exercise mode or sleep mode, you're seeing in you know, my weekday profile, for example, I know my son plays basketball every day from three to seven so we're going to create a profile that changes his blood glucose target for that period of time, perhaps starting you know, before he plays a little bit and then extending after and that's an actual profile in the pump that you then could change. Okay, perfect. All right, that's really interesting. Is there an Is there a and I hate to use Tandem is word sorry, is there an exercise mode or a sleep mode? Or is it just the user sets it as they want?   Right back to Dr. Ly answering that question. But first Diabetes Connections is brought to you by tchibo hypo pin and you know, low blood sugar feels horrible. You can get shaky and sweaty or even feel like you're gonna pass out there are a lot of symptoms and they can be different for everyone. I'm so glad we have a different option to treat very low blood sugar Jeeva hypo pen, it's the first auto injector to treat very low blood sugar chivo Kibo pen is premixed and are ready to go with no visible needle before Jeeva people needed to go through a lot of steps to get glucagon treatments ready to be used. This made emergency situations even more challenging and stressful. This is so much better. I'm grateful we have it on hand find out more go to Diabetes connections.com and click on the G book logo g book shouldn't be used in patients with pheochromocytoma or insulinoma visit Jeeva glucagon comm slash risk. Now back to Dr. Ly. Going into more detail about how the Omnipod 5with horizon system works.   Dr. Trang Ly  14:36 Separate but yes, what you describe is exactly how our product works or during the day. It might be that you want your son to run out 110 through the day but maybe between the hours of three and seven you'd run at 140 that is an option. And you can set that up pre programmed so that he doesn't have to remember to do that every day or you can run in what we call a hyper protect mode, which is work similarly to like attempt days or that you you'll be familiar with. So that's more of an ad hoc, oh, I feel like exercising for the next two hours, I'm going to set my program in hyper protect mode. And hyper protect, what the system does is it adjusts your target glucose to 150. And it actually gives you less insulin than your basal insulin. So you're running essentially with less insulin on board than you would normally would during that period. And so we we did a lot of studies to kind of land on that design. And we feel that he does a good job of preventing hyperglycemia for, for people without problems asked afterwards. So it has worked well, because it doesn't, you know, sometimes, when you're preparing for exercise, you might take a snack, and that drives your blood glucose up. And then if you have a really robust algorithm that might kick in and give you a fair amount of insulin. So that's what we were trying to avoid with our design was that not just that the setpoint is elevated, but also that the system can't give too much insulin during that time. So that's sort of our equivalent exercise mode. We don't have anything called sleep mode. But as I said, our set point of 110, you know, once were created will be the lowest available in the United States.   Stacey Simms  16:30 One of the things I've learned recently, and I I feel like I haven't seen this reported very widely, is that, unlike Tandem control IQ, the Omnipod system, the Omnipod, five with horizon, learns the user it changes, it has a little bit of I guess I call it artificial intelligence. Is that correct? And can you walk me through what I'm saying? What I mean by that? Yeah.   Dr. Trang Ly  16:56 Yes, yeah, I think I think you're I'm getting to a really key difference between our, our system and others. So with, with our system, when we, when we were developing it, we wanted to reduce the work that comes with diabetes, as well. And so you know, a lot of the work that comes with that is adjusting those or rate adjusting, you know, all the settings and things like that. And so our system, initially, when you, when you have it out of the box, it does rely on your basal rate to start off, automated insulin delivery. But over time, the system learns through the turtle Gary informed that is delivered by the system. So the system knows about this, and can rely on this information, because it's reliable come through the system to augment insulin delivery. So you might have a small child who only has 10 units of insulin per day. Now system is not going to give too much insulin, based upon the fact that it knows that in the last few days, it's never given more than 10 units a day. And so the safety constraints are personalized for that user. And on the opposite end of the spectrum, know, we have users that use 100 units a day. And in that case, the algorithm knows that it can give a lot more insulin, and this person will tolerate it quite fine. Because you know, when you have insulin is unlikely to make much difference for this person who takes 100 units a day. And so as it accrues that information over time, the algorithm does adapt the ability to know how much insulin it delivers based on that information. So what it means is that, in order to get the results we got, you know, you're not having to tweak basil rates on an hourly basis. Sometimes I've seen, you know, people have different basil rates every hour. And what we're really striving to do here at Insulet is create products that reduce burden for people. And that includes including, you know, optimizing settings, so that people can get, you know, so that everybody can get good glucose control and, and not have to rely on perhaps educators and clinicians at the academic centers who are familiar with these devices to really get those good results.   Stacey Simms  19:38 So I'm just trying to understand the the automatic adjustment that you're talking about there based on the total daily insulin. So if after a few weeks of using Omnipod five with Horizon, a person should expect to not adjust basil rates should like what should they be seeing because if like let's say as someone has six different basil, right When they start on the system, what what's happening? Right? What's going on? Are they Is it like the other systems where it's adjusting every five minutes, it's giving you boluses. If needed you How is the smartness of the of the pump working there?   Dr. Trang Ly  20:12 Yes, if you had six different rates running for 24 hours, initially, the algorithm would take that information and would have bent in front of every every five minutes based upon the inputs that were provided to the system, as well as how your CGM is tracking how much insulin on board, you have all of those things. So at all times, the system makes a influence decision every five minutes. So that occurs, as soon as you put the system into automated mode. That happens all the time. And when people ask me about order corrections, I say, yes, this system automates and make some adjustments every five minutes to drive you towards your target glucose. So corrections are incorporated within the system, we don't consider any difference between basil modulation and what was modulation of insulin is insulin. So every five minutes, you're getting a essentially order correction if you need it. But that works very similarly to, you know, the systems that are currently on the market. And over time, the those six basil programs that you have really not utilized in the system at all beyond that first part. And so if you are running high for whatever reason, and you know, you you tweak other things, but not your basal rate. And so I'd say in in that way, you know, our system is more similar to the Medtronic system. And in that way that the basil rates do not directly inform automated insulin delivery. But things that are still under your control at all times is influence coverage, share your correction factor, target glucose, correct above all those settings that have always been within on the pod, and also very similar across many bolus calculators all stay the same. So you're always going to be sort of always going to be directly in control of all those fat. And so if you're running high, it might might be that you need more corrections over time before your system adjusts to that higher insulin requirement. But   Stacey Simms  22:34 you're in control, oh, wait, target number, but only only down to 110? That's right. Gosh, I have so many questions with the automated systems. I think you mentioned this, but I'm not sure. What about insulin duration, is that something that the user can change? Or is that something that is set,   Dr. Trang Ly  22:50 so there, so the Dow system, the user can change that, and how it manifests itself is that it will inform the duration of insulin action for all those manual boluses that you deliver. So if you're someone who's very sensitive to insulin, and it hangs around for a really long time in your body, and you have a six hour early insulin action, then you can program that until you know your bolus of insulin that you deliver at 6am in the morning, that's going to take till midday before it disappears from the system, as it knows that all of those will still be accounted in the same way with the duration of insulin action that you provide to the system. In terms of the automated insulin delivery, we have the intellects, proprietary duration of insulin delivery, that is the input to the insulin model from which we deliver that insulin that is consistent, and is just one value. And it's the same value and the algorithm that's been tested across the board from in all of our clinical trials. So that does not change, and is within the algorithm that dictates that five minutes away insulin delivery.   Stacey Simms  24:11 To me, that was one of the big surprises of using an automated system. We have, you know, My son is 16. And we started using an automated system when he was what 14. So you're in the middle of those fabulous teenage years, and he's using tons and tons of insulin. And it seemed to me that we needed an insulin duration of like two to three hours. And when they switched it on Tandem. It's it's five, I really fought on that thinking this is going to be a disaster, and it was fine. It worked really well. So it's one of those interesting things once you get an automated system and realize this is my opinion, once you realize how much work you were doing to try to stay in range. It's kind of nice to let that system take over once you trust it. And I would assume that that's what you found in these studies. I mean, you mentioned that people spent more time in range, but let me give you the floor. Take a minute or two to talk about. I've seen the study You know, you've been kind of putting them out with different age groups over the last couple of weeks and months, take a moment to brag about the studies.   Dr. Trang Ly  25:08 Yeah, we're so grateful to the diabetes community who really gave this product life through our clinical studies. So I'm just deeply grateful for every patient and family who took part in it. Because without them, you know, be a product, but it wouldn't be Omnipod. Five. And so it was really a ton of work that we I feel like has been many years in the making. Yeah, we've worked really hard on this algorithm to get it pretty much as good as it could be. And, you know, back in 2019, as we were preparing to do these clinical studies, I really wasn't sure about how our results would stack up. But I have to say that I'm completely blown away by how well our algorithm has performed. So in the talk first about our six to 70 year old age group. So the first lot of results that came out came out in March of this year, we had essentially two groups. So we had the children, which were six to 14 years of age, and then the 14 to 17 years of age, which is the adolescent and adult group. So I was just covered the adult group there. So we saw and time in range improvement to 74% in the adult Group, a once the reduction down to 6.8%. And then very minimal hyperglycemia. If you look at our hypo compared to other published data out there, it's the lowest hypo, which we measured by time under 70, compared to all the other groups. And in terms of the children, there's six to 13.9 years of age group, we got to a timing range of 68%. And this was equivalent to 3.7 hours per day improvement. So really remarkable improvement in timing range. And in terms of a one see improvement, we got that down from 7.7%, down to 6.99%. So really remarkable reduction in a one C. And what's super, super exciting is that just recently at Ada to see or wishes a couple of weeks ago, we showed that in the extension faces after the main three month pivotal study, everyone could continue using it if they chose to. And we saw a further reduction in a one C, which is just incredible. So in both the adults and children, we saw a continued decline in a one C. So just really super exciting to see that, you know, our product continues to be helpful for these patients with diabetes.   Stacey Simms  28:05 Let's talk a little bit about the the setup of the system. You know, when in the very beginning of the interview, I asked you to kind of describe it. And it's Omnipod Dexcom, G6, and then a controller of some kind. Let's talk about the controller. Last I had heard this was going to be the PDM. If needed, the more traditional I guess you'd call it but you'll expLyn it to me or an Android phone. Tell me about the controller in the short term. And then we can talk about what you're planning.   Dr. Trang Ly  28:32 Yeah, that's right. So we will have the controller device. So we have an Insulet provided controller, which our were choosing to use that word over PDM. Because not everyone knows what a PDM is that yes, that controller device, we will always ship with our product. And so you will be able to use that in a locked down device which can only communicate with pods and can't really do much else with it. And but users will have the option to download an app from their from selected android phone to also have that same experience. So it's the exact same app that would be that would exist on the controller. And you would be able to essentially control your parts and replace that controller with the Android app.   Stacey Simms  29:25 I should have said the PDM stands for what personal diabetes manager. That's right. Okay. So that's an antiquated term now, though, so we'll put that aside. But to be clear, so if I have the right Android phone, you're seeing this is not a lockdown Android phone, I can get this the app and I can use my personal phone to control my Omnipod five with horizon system.   Dr. Trang Ly  29:47 Yes, that's right. That's what's currently in front of FDA right now.   Stacey Simms  29:51 Do you know and again, if it's up to them, or you can say I know we're limited sometimes what models or is there a list somewhere?   Dr. Trang Ly  29:57 Yeah, we haven't. I don't think We have indicators or phone models that will be available at any time. But we'll do that soon after launch will list those out that they will be as the first offering selected Android phones.   Stacey Simms  30:14 And I would assume the plan is to eventually go to all types of phones, including apple. That's right. My question for Omnipod is always what I'm about to ask you. But phone control makes it a little bit obsolete. And that is why no button on the pod why not even like a one dose one unit or something on the pod?   Dr. Trang Ly  30:34 I've been asking this, since I've had the podcast. Yeah, I think he just originated with the original design. And I think perhaps, because it really started originally with the idea of children using our device, and having that separate controller to track all the information. I think just at that time, because it was primarily a product for children, we wanted to make sure that infant delivery was always, you know, very intentional, and not unintentional. And so would always to have that remote control potential and and not have any, you know, button on the pod, which could lead to accidental or insulin deliveries, unintended,   Stacey Simms  31:21 or just a couple of laundry list type questions. Dexcom has already announced that they're going to seek FDA approval for the g7. Soon, I would assume that Omnipod will eventually, you know, work with the g7, which should users should be concerned at all about that kind of compatibility?   Dr. Trang Ly  31:38 Yeah, I think eventually, you can expect that, you know, systems that are integrated with G6 Today, we'll be working towards g seven in future. You know, I think the whole idea of interoperability reach was beheaded by the FDA really enables companies to work faster to integrate with future versions of systems. So you know, we we want to be at the leading edge of that innovation. And I think that will come with time. We I don't think we've announced any times or dates regarding that. But it is something that, you know, we fully intend to support.   Stacey Simms  32:17 And this may be another business type question. But everyone who's using Omnipod right now, what's the plan for current customers? We're getting ahead of ourselves, I know the system's not approved. But can people using arrow so dash expect to kind of be seamlessly switched over to Omnipod? Five with horizon?   Dr. Trang Ly  32:35 Yeah, I don't think we have released all the information regarding how we're going to transition our current customers. Yes, I don't think that that is publicly available yet. But we, you know, one thing we do strongly believe in is supporting our current customers. And what we have said is that Omnipod five will be available via the pharmacy channel at price parity kadesh. And so what that means that if you are already receiving cash today that you're going to be in a very good position to have coverage for Omnipod. fi. And but we haven't detailed the information regarding you know, how we're specifically transitioning every single patient at this, at this point,   Stacey Simms  33:25 separately from the pod. tide pool loop is also in front of the FDA, as you and I are speaking, I'm not even quite sure really what to ask you about this doctor, like because I know it's coming from tide pool. But can you share anything about the relationship from Omnipod to Tandem? And how the loop project is going? It's kind of a it's a different animal kind of out there. But I don't want to leave without asking you about it.   Dr. Trang Ly  33:51 Yeah, you just said Omnipod to Tandem, but I'm   Stacey Simms  33:54 so sorry. Yes.   Dr. Trang Ly  33:58 Yes, yeah. Well, that is title program. So it's best that you speak to Howard about that. But it is a program that we support. And and we certainly, you know, believe in interoperability and supporting points for our users. And yes, you're right. I believe the last update is that it is currently under review with FDA wouldn't use the dash parts, or does it use it with Omnipod? Five. So it's, it's not it's not going to be backwards compatible with dash pod   Stacey Simms  34:35 guidance. My next question was, so if Omnipod five with horizon is approved, Omnipod is manufacturing the same pods for both systems. That's right. I know you know, I'm not sure we're supposed to talk about it. But I know you know, because you've spoken to the loopers groups and you speak to people all the time that there's a bunch of people using the older pods, the arrows, pods, I believe for a nod FDA approved system, they're looping with the separate from title loop, they're looping with those pods is only going to keep making those pods once this new system is approved,   Dr. Trang Ly  35:10 we haven't said exactly when we will stop making those pods. But I think the community should expect which and I know that they already do that at some point in time in the near future, we would need to stop making those pods. And that's for a variety of reasons. But as you will know, Stacy, and many of your audience will know, you know, that is much older technology. And you know, we prioritize innovation that is going to work well and be safe for our users. You know, that's partly why we moved to dash to integrate Bluetooth technology. And then which has enabled us with Omnipod, five to talk via Bluetooth to CGM. So that type of safe integration is really important to us in our future offerings of product. And so at some point in time, that will, we will need to start making that and also, you know, that is with all the technology, all the components, and etc. So, once that happens, though, we will let the community know with sufficient time so that people can prepare for alternative methods of therapy. And hopefully that will be Omnipod. Five,   Stacey Simms  36:25 you've been so generous with your time, I just have a couple of more questions. I really appreciate it. One of the questions that was asked in the podcast Facebook group was when approved, how will the training for this go? In other words, with control IQ, I sat down, I took a course I took a quiz. And once I passed it, my doctor had written a prescription. And we got the downloadable, you know, into the pump. And we were off and running did not meet with a diabetes educator or an endocrinologist to learn how to use control IQ. What will the system be for teaching people and getting Omnipod? Five to them?   Dr. Trang Ly  36:58 Yeah, so for people who are already using Omnipod dash, you can expect that the experience will be similar to what you just described for control IQ. So you will not have to meet someone in person in order for you to start that system up. So it will be similar in a training quiz, number of steps. But you can do it all self directed and be often running on Omnipod. Five, or you can choose to speak to someone or meet in person with an educator if you wanted more information about for instance, how the algorithm works or whatever question you had on your mind. But for brand new users who've never used a pump before, then it will there will always be in person training, or virtual training. You know, there's some things that you we still feel that is necessary to cover, you know, basics of pump therapy that will require meeting with their certified trainer to go through. But yes, we're current on the Pog dashes as you can expect the transition to be fairly seamless.   Stacey Simms  38:08 Another question that came up was about insurance coverage, but particularly Medicare. Can you speak to that? Yeah. So   Dr. Trang Ly  38:15 currently, we have Medicare coverage under Part D, which allows for pharmacy coverage of the pod. So we do have that. And they only came in recently in the last I'd say three years or so. So once that came through CMS, we worked with many plans to get Omnipod covered under that peptides for Medicare. So one of the things that, you know, we're working on well, FDA clearances, is still under review, we are working on making sure that we get as many people covered as possible. When Lord, they come. So yeah, it's a major priority for us to make sure that our patients get covered for this product.   Stacey Simms  39:06 You referred back a couple times to your days as a pediatric endocrinologist. How exciting is this for you? You know, the people that use this product, you know, the people that use other automated pumps. Can you speak a little bit just from your personal side about the excitement because you know, this is going to help people?   Dr. Trang Ly  39:25 Yeah, it's just incredibly exciting. And maybe not everyone knows about this. But yes, Stacy, as you mentioned, I am a pediatric endocrinologist. And it's actually about 10 years ago now, but I did my very first study in automated insulin delivery and that was back in Perth in Western Australia. And in that study, we use a Medtronic pump add to Medtronic sensors and a blackberry phone and the algorithm was on a blackberry phone and it was I haven't mentioned this to many people. But those those sensors were, you know, were challenging at times to deliver insulin from. But it was such important studies, in terms of proof of concept to show that, you know, we could augment insulin delivery and, and making that decision every five minutes gets you in better glucose control. And it was really extraordinary. And I still remember the very first time, the very first patient that I put the system on, and, you know, and I was watching that insulin being delivered. And I remember just like hugging the participants, Mom, because, you know, we just both knew how incredible this was going to be if, if this could reach masses of people, it's always been for me, something that will be realized. And, you know, it has been through really great products like control IQ. And you know, soon Omnipod five will be out with a great algorithm. And because we just know that this type of technology is what is going to allow parents to sleep at night and let people be comfortable with their diabetes and be more confident about it so that they can focus their brains on other life decisions and not be so consumed by their diabetes. And so it is really incredible for me to be able to see the results of our algorithm just works so well in such a huge population of patients, even in just in clinical trials today. And I just know that there's going to be incredible impact from this product in future when we launched.   Stacey Simms  41:47 Well, thank you so much for coming on and sharing so much information. We're all excited to see what happens next. And I hope that you are you know, other folks or Insulet will come on and share more information, you know, fingers crossed as the rollout happens. So thanks so much for joining me.   Dr. Trang Ly  42:02 Thank you so much. So happy to be on.   Announcer  42:09 You're listening to Diabetes Connections with Stacey Simms.   Stacey Simms  42:15 Lots more information at Diabetes connections.com. I know the one question everybody asks that we cannot answer is when will this be available, it will be available when the FDA approves it. And you know, that could come any minute it could come in a few months, you know, we are not privy to that information. But once it is available, it will take a little while to roll out. So Omnipod I'm sure we'll make a lot more information available as we move forward. We'll talk to them again. And we will answer as many questions as possible. Also got a lot of questions about insurers, that's going to depend as well, quite often, insurers will not initially cover new products. I know Omnipod is talking with everybody. But it may take a little bit of time. So we'll circle back on all of that it is difficult to pick and choose the listener questions that I asked but I really try to focus on what I know the person that I'm talking to can answer and I thought Dr. Ly was was really fabulous and spoke to me frankly, for longer than I expected. So I really appreciate her sharing so much information with us. And I hope you found that helpful. All right. Diabetes Connections is brought to you by Dexcom. And I do want to talk for a moment about control IQ. You heard me mention that several times during the interview. That is the Dexcom G6 Tandem pump software integration. When it comes to Benny's numbers, you know, I hardly expect perfection I want I'm happy I'm healthy. I have to say control IQ has exceeded my expectations, Vinny is able to do less checking and bolusing and is spending more time in range. His last couple of Awan C's were his lowest ever and this isn't a teenager, the time when I was really prepared for him to be struggling. His sleep is better to with basil adjustments possible every five minutes, the system is working hard to keep them in range. And that means we hear far fewer Dexcom alerts, which means everybody's sleeping better. I'm really so grateful for this. Of course individual results may vary. To learn more, go to Diabetes connections.com and click on the Dexcom logo. Before I let you go, we're actually traveling this week. So the interview with Benny about Israel is coming up and thank you so much for all of the questions that you have sent in. There was a Facebook group posted Diabetes Connections of the group. If you want to chime in and ask me some questions to ask my son who recently got home from one month overseas. He is 16 and he was with a camp group but it was not a diabetes camp. He's home safe and I've done some debriefing with him. It was really interesting. And Gosh, teenage boys. So interesting. I can't wait to share some of his stuff with you. And some things I'm not sure I will share. No I mean we're pretty much an open book but he right he doesn't really handle diabetes exactly the same as I would but home safe and sound and really did very, very well. reminder that on Wednesdays I do in the news live On Facebook on Diabetes Connections, the Facebook page, and that becomes a podcast episode on Fridays I, as I said, I'm traveling, so hopefully technically all will go well, we shall see. But that in the news episode has become a lot of fun, frankly, and people really enjoy that still short, so I'll put that out as well. And then in the weeks to come, I have some great interviews for you. We have interviews about sports and being very active. I have an interview with the folks that have Afrezza that I'm really excited to bring to you. It's been a while since we spoke to them. And of course, that interview with Benny, so lots to come. thank you as always to my editor John Bukenas from audio editing solutions. I thank you so much for listening. I'm Stacey Simms. I'll see you back here in just a couple of days until then, be kind to yourself.   Benny  45:46 Diabetes Connections is a production of Stacey Simms Media. All rights reserved. All wrongs avenged

Are you trying to create a good habit or break a bad one? That's Dr. Jud Brewer's speciality.  Dr. Jud (MD, PhD) has over 20 years of experience with mindfulness training and a career in scientific research. His interest in how the brain works has led him to work with people to make deep, permanent change in their lives. He has developed mindfulness programs for habit change, including in-person and app-based treatments for smoking, emotional eating, and anxiety. Earlier this year, Dr. Jud released a new book, “Unwinding Anxiety - New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind.” His book is a clinically proven step-by-step plan to break the cycle of worry and fear that drives anxiety and addictive habits. Dr. Jud explains how to uproot anxiety at its source using brain-based techniques. Check out Sonya's previous interview with Dr. Jud in early 2020 about how to overcome bad habits and cravings using the power of the mind. In this episode, Dr. Jud talks about looking at anxiety as a habit and not relying on willpower to change that habit. He also speaks about curiosity and mindfulness. 

To support this ministry financially, visit: https://www.oneplace.com/donate/222/29 If you were interested in flying a plane or performing surgery, you’d go to flight school or medical school. But where do men go to learn to be godly men? That's Dr. Evans' subject for this lesson as he talks about why men need the church.

Do you know often I'm asked if someone's partner, spouse or kid is a narcissist? Its a lot. But narcissists are relatively rare, and its hard to discern who is a clinical narcissist, and who is not. So let's talk about it! We'll look at the traits that make a narcissist, and then its story time! Story Time: 9:55 - Its Not Me, Its You 15:00 - That's Dr. Narcissist to You Follow us on Twitter - @SomeTalesFrom Email Us - SomeTalesFromTheChair@Gmail.com

It's the soap with unforgettable packaging: tiny print with big messages. That's Dr. Bronner's — a company that instantly captivated me with their 6 Cosmic Principles centered around the idea of “All-One.” Their “Cosmic Principles define our most important relationships, and guide us in everything we do, from soap-making to peacemaking.” Check out the Heal Soul label for just one recent example, on supporting psychedelic-assisted therapies. Join me in conversation with Dr. Gero Leson, VP of Special Operations and author of Honor Thy Label, on navigating the complexity of a global values-based business that truly walks its talk. More about Gero: Dr. Gero Leson is Vice President of Special Operations at Dr. Bronner's, the top-selling brand of natural soaps in North America. After joining the company in 2005, he helped it transition to sourcing all its major ingredients directly from certified fair trade and organic projects. Under his leadership, Dr. Bronner's has become a pioneer in the global movement to establish socially just and environmentally responsible supply chains. His new book is Honor Thy Label: Dr. Bronner's Unconventional Journey to a Clean, Green, and Ethical Supply Chain. Gero even got his own label and soap related to the book! Check it out here :) ❤️ Enjoying the show? The best way to thank us is by leaving a rating or review. Free Time is listener supported—consider donating to become a podcast Insider and you'll get access to a private monthly Q&A call with Jenny.

Listen and subscribe at www.JustProWrestlingNews.com I'm Matt Carlins and this is JUST Pro Wrestling News for Thursday, February 17, 2021. A special welcome to those of you listening on TheWrestlingRevolution.com. If you want to bring our updates to your website...email us: desk@justprowrestlingnews.com. Fans and even some wrestlers got a scare late Wednesday night into early Thursday morning - the result of some very effective storytelling at the end of NXT...and after the show went off the air. Adam Cole staged an attack on Kyle O'Reilly during the show's main event. O'Reilly remained motionless. After the show ended, O'Reilly was taken out on a stretcher. Some live fans in attendance speculated that O'Reilly suffered a seizure...and that nugget of misinformation spread like wildfire online as fans...and even some wrestlers expressed their concern. Early Thursday morning, Wrestling Inc. was first to report that O'Reilly is fine. This was all part of the storyline...and never intended to look like a seizure. That Adam Cole ambush came during the main event 6-man tag on last night's NXT. It was O'Reilly and Roderick Strong teaming with Finn Balor against Pete Dunne, Oney Lorcan and Danny Burch. The end of the match saw Balor catch Strong with a no-look kick - apparently by accident. Dunne then snuck up on Balor, hit the Bitter End and pinned the NXT Champion. After the match, Cole delivered another superkick to Balor..The final shot was Cole holding up the NXT Championship. The women's tag team champions Shayna Baszler and Nia Jax were on NXT...to trade barbs with Dakota Kai and Raquel Gonzalez. The title match between those teams is now set for the March 3rd episode of NXT. Days after he was ABDUCTED backstage during TakeOver...Austin Theory was found safe. Johnny Gargano retrieved him from a white van that pulled up outside the Capital Wrestling Center. Leon Ruff beat Isaiah SWERVE Scott...and that brought out a violent side of SWERVE after the match. The match between Santos Escobar and Karrion Kross that was announced last week did NOT happen. GM William Regal said if Escobar doesn't show next week, he'll be stripped of his cruiserweight title and suspended indefinitely. Today's NXT UK has A-Kid defending the Heritage Cup against Sha Samuels...and Joe Coffey vs. Rampage Brown. (STINGER: New Japan) A knee injury is sidelining one of New Japan's biggest stars. Tetsuya Naito will miss the Road To Castle Attack shows on Friday and Saturday. Naito was a late scratch from Wednesday's Road To show. Naito suffered the injury during the main event of Tuesday's show. He assured fans Wednesday that he still plans to challenge Kota Ibushi for the IWGP Intercontinental Championship at the Castle Attack show on February 28. (STINGER: AEW) Some big pieces - including the main event - of AEW's Revolution pay per view - taking shape during last night's Dynamite. Last night's show ended with Kenny Omega revealing a rematch clause in the contract from the match where Omega took the AEW Title from Mox. Omega said the rematch will happen at Revolution...and that it will be an Exploding Barbed Wire Death Match!!! Moxley had just pinned Eddie Kingston to win the 6-man tag team main event. The Young Bucks will defend the AEW Tag Team Championships against Chris Jericho and MJF at Revolution. The Bucks survived a title challenge from Santana & Ortiz last night. The entire Inner Circle attacked the Bucks right after the match. Kenny Omega and the Good Brothers were shown backstage WATCHING this happen. The Good Brothers eventually ran out to ringside after a few minutes. The uneasy alliance between Handman Page and Matt Hardy is already over...and they will clash at Revolution. The winner gets 100% of the loser's earnings from the first quarter of 2021. Tully Blanchard will return to the ring at Revolution, teaming with FTR against all three members of Jurassic Express. By our calculations, it will be Tully's first match since 2007. Riho was victorious in her return to Dynamite. She used the Gedo Clutch to pin NWA Women's World Champion Serena Deeb - advancing in the Women's World Championship Eliminator Tournament. The final two first round matches on the U.S. side of the bracket will be shown on AEW's YouTube channel Monday night at 7PM. That's Dr. Britt Baker vs. Anna Jay and Tay Conti vs. Nyla Rose. We'll also get BOTH semifinals from the Japan side of the bracket - Yuka Sakazaki vs. Emi Sakura and Aja Kong vs. Ryo Mizunami. There will be a 6-way ladder match at Revolution to determine the next challenger for Darby Allin's TNT Championship. Three of the participants were announced last night: Cody Rhodes, Penta El Zero M and Scorpio Sky. Speaking of Darby, Team Taz finally got the better of his tag partner at Revolution. Sting confronted Team Taz in the ring...only to be put down with a powerbomb from Brian Cage. That's JUST Pro Wrestling News for Thursday, February 17. Our next update comes your way tomorrow morning, so be sure to subscribe to this feed. We also thank you in advance for leaving a glowing rating or review.. I'm Matt Carlins. Thank YOU for listening. ~~~Full run down at www.justprowrestlingnews.com ~~~ • • • • • wwe #wrestling #prowrestling #smackdown #wwenetwork #wweraw #romanreigns #ajstyles #NXT #raw #njpw #wwenxt #SethRollins #TNA #johncena #RandyOrton #wrestlemania #ROH #WWF #summerslam #tripleh #aewdynamite #professionalwrestling #aew #allelitewrestling #aewontnt #DeanAmbrose #nxt #KevinOwens #wwesmackdown @wrestlinginc @heelbynature @mattcarlins

Hey members! First and foremost, THANK YOU. Your willingness to support this podcast early has been an incredible sign that maybe, just maybe, we're on the right track with the message of the show. We're working hard on our end to make sure we don't let you down. It's a big day. We're launching this new podcast. If you haven't ever launched a podcast, it takes a mix of audacity, old-fashioned spirit, and a tolerance for no small margin of public speaking terror to get the job done. But who are we kidding… of course you've launched a podcast. Everyone has a podcast now. My name is Pete Wright and I'm your chaperone. As such, I write little letters to you, like this one, as well as introduce episodes, giving you a sense of what you're going to experience on the show. As a subscriber, you'll hear my voice from time to time, and as a patron, a good bit more as I join Dodge in our private Afterthoughts series. But this is Dodge's show. That's Dr. Dodge Rea, Psy.D., Integrative Clinical Psychologist and co-founder of The Lotus Center, an integrative health center in Nashville. He's been one of my best friends for nearly three decades. I believe you'll soon come to see why he's so well loved by clients, colleagues, and old friends alike. In our grand episode one, we're going to introduce you to Ben Rea. Ben is a Licensed Clinical Social worker and co-founder of Healthy Minds, his practice in San Luis Obispo, California. He's a phenomenal psychotherapist in his own right but also Dodge's younger brother, which makes our first episode that much more special for all of us. Ben joins Dodge for a conversation on ACT, Acceptance and Commitment Therapy, plus a round of “where was that picture” and other lessons learned from their childhood home. A few notes on the episode. First, we recorded the thing without the intention of releasing it to the public. It was a test. But in the same way that you can't return all the feathers to a pillow in a windstorm, we just couldn't figure out a way to recreate what Dodge and Ben captured in their first conversation. Call it beginner's luck if you will, but something unexpected happened that demonstrated change far better than anyone could have explained it. I encouraged them both to take a risk and put listeners on notice: This will be be a remarkably brave and authentic podcast. Dodge is in this with you. Second, this episode is chock full of gems that have branded themselves on my psyche in the months since we recorded. On reflection, they all revolve around the fascinating idea that we continue to experience our lives through the entrenched stories we tell ourselves, and only in moving toward the pain we want to run from do we find the freedom to change it. This is something the brothers weave their way through in the course of their conversation and the lessons — at least for me — have been powerful. I hope they are equally so for you. Thanks for joining us on this journey. We're so deeply gratified you're here. — Pete Links & Notes Ben Rea, LCSW About ACT — Contextual Science

In this episode of the Versatilist Happy Hour, Amy, Jen and I talk about how VR can be used to ease chronic pain, the fearful new features of smart AR glasses, cool new AR features for Lovecraft Country (a show you should definitely be watching regardless), ask why Zoombombing is still a thing. For more information, check out the following links: https://www.medpagetoday.com/meetingcoverage/asipp/88489 https://www.designboom.com/design/put-a-snapchat-filter-on-everyday-life-ar-goggles-concept-09-08-2020/ https://www.tribuneindia.com/news/science-technology/facebook-unveils-ar-glasses-with-auditory-superpowers-137378 https://dnews.com/local/pullman-schools-victim-of-zoom-bombings/article_8364ba4b-013f-5b47-92dd-97d701624ecf.html https://www.youtube.com/watch?v=TATSAHJKRd8

Who better to disrupt the healthcare system than a Stanford- and Harvard-trained physician-scientist, entrepreneur, inventor, and innovator with more than 25 years of experience in clinical practice, biomedical research, and healthcare transformation? That's Dr. Daniel Kraft, our guest on this week's episode. Kraft is the brain behind IntelliMedicine—think personalized prescriptions you 3D print at home—and says the future of healthcare is being built by astrophysicists, gamers, and maker folks, not by doctors and biotech researchers. Tune in to hear why he calls the COVID-19 pandemic our Apollo 13 moment and why he thinks we're in the midst of a practice pandemic. (Yikes!) Download the executive summary for this episode at manonfire.co. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Amir Georges Sabongui completed an undergraduate honours degree in Experimental Neuroscience specializing in stress and addictions research before completing a Master's degree in developmental clinical psychology.After serving over 10 years as a senior officer in the Canadian Navy specializing in naval operations and military crisis intervention, his Doctoral research focused on identifying and activating resilience factors to protect soldiers from the impact of armed conflict.He is the recipient of numerous awards and distinctions, including the Award of Excellence from the Canadian Psychological Association.Today, he uses his in-depth knowledge of applied leadership and resilience to work closely with Canada's largest corporations to develop burnout prevention and recovery programs as well as workplace mental health initiatives.Dr. Sabongui has helped many corporations create healthier work environments for their employees, include Alcan, Bell, CAE, CBC, TD Bank, Canada Post, Fairmont Hotels, Rogers, Sears, and more. He also works with professionals on a one-to-one basis.More personally? Dr. Georges, as he's commonly referred to, is an incredible human being and psychologist who pretty much saved my soul. Have you ever met someone whose impact on you can never be sufficiently repaid? That's Dr. Georges. He's a person who still today has far reaching implications on and in my life despite having spent only two hours in his office. There's a saying “when the student is ready the teacher appears.”Here's how you can connect with Dr. Georges:LinkedIn: https://www.linkedin.com/in/dr-amir-georges-sabongui-phd-5777712/Website: sabonguisos.comEmail: contact@SabonguiSOS.com

Donna's Question:  Hello. I'm 62 years old with a uterus. Recently my nurse practitioner switched me from 6% progesterone cream to Prometrium capsules. The amount of cream I was using was 1/4 teaspoon two weeks out of the month. She also added in the Intrarosa vaginal inserts instead of the estradiol cream for vaginal discomfort. I do not have many symptoms other than occasional sleepless nights and occasional hot flashes. My question is are the Prometrium capsules safe? And is the cream safer than the capsules? Thank you, Donna. Short Answer: Both Prometrium and bioidentical progesterone are safe to take. However, many women do not seem to tolerate Prometrium very well. Prometrium is instant release, which seems to make it less tolerable for some women. In most cases, we prefer to us sustained-release progesterone, which is typically better tolerated by most women. This is important for women taking estrogen who still have a uterus. Estrogen causes the uterine lining to thicking and oral progesterone inhibits this thickening. Progesterone cream does not inhibit the growth of the uterine lining, which is why we prefer to prescribe oral progesterone for our patients. PYHP 088 Full Transcript: Download PYHP 088 Transcript Dr. Maki: Hello, everyone. Thank you for joining us for another episode of Progress Your Health podcast. I'm Dr. Maki.  Dr. Davidson: I'm Dr. Davidson.  Dr. Maki: How you doing this morning?  Dr. Davidson: I'm doing great. Thank you. How are you?  Dr. Maki: Pretty good. Pretty good. You were surprised by that question? Dr. Davidson: Yes, a little bit [laughter].  Dr. Maki: Why are you surprised? Dr. Davidson: Because we've been hanging out all morning. [chuckle] Now you're asking me how I'm doing. Dr. Maki: Well, we had to start over on this podcast a couple of times, so that's okay. That's… Dr. Davidson: I felt like I had rocks in my mouth. So I'm like, “Just stop it. Let's start it over.” So I think this one will be the one [chuckle]. Dr. Maki: Yes, yes. So this one is a question we have from Donna. So why don't you go ahead and read it? Dr. Davidson: Oh, okay. So yes, this is a listener question from Donna, it says, “Hello. I'm 62 years old with a uterus. Recently my nurse practitioner switched me from 6% progesterone cream to Prometrium capsules. The amount of cream I was using was 1/4 teaspoon two weeks out of the month.” So it looks like they were trying to cycle the progesterone or cycle the hormones. “She also added in the INTRAROSA vaginal inserts instead of the estradiol cream for vaginal discomfort. I do not have many symptoms other than occasional sleepless nights and occasional hot flashes. My question is are t

Okay, welcome KBMD health fans and gut check project fans, it's time for COVID installment number two. These are the code files where essentially, myself and Dr. Brown, a co host we're going to address the latest in research for coronavirus as it applies to healthcare and our community. Dr. Brown, how are you doing?You know I'm doing is I'm doing well considering the state of how a lot of people are probably struggling through this process. Once again, the COVID files I think you and I really enjoy joking around and stuff, but this is not something that I want to joke around with today. So the show right now we're becoming much more sciency than we've ever been. And it is because I want to make sure that anything we discuss has a reference to it. So let's begin by saying that this is a show and not intended to treat diagnose anyone. I'm a medical doctor. With the current state of anxiety I'm trying to sift through hundreds of articles being published daily because this is a global problem. And I am fortunate enough to have our secret weapon which this week I was on Dr. Chang Raun's in Darrel Hill summit with Dr. Hyman and some other incredible people, Dr. Pompa, Dr. O'Brien and all these people and I, I told them all that Angie Cook is our secret weapon. And then on the CBOE SOS summit yesterday with Chevonne Sarna, I let it drop again. So Angie, thank you so much for working hard and diligently with me to try and get through all of this literature. Cats out of the bag. She is a certified nutritionist and Rn one of the smartest people I've ever met, and she sent me this email right before we went on. Today the numbers are staggering and the stories of what our healthcare workers are facing is heartbreaking. Please be careful. So what we're going to talk about today is mind blowing, to be honest. And I'm just going to be honest. In the sense this is no, this is not opinion. This is not based off of anxiety, or based...this is strictly the science. And this is not the time that I want to, I want to be perceived as I mean, because one of the concerns Eric, you and I've talked about this, I want to shout everything that I've learned from the rooftops, but I don't want to come off as somebody that's saying that I want to try and make money off of this particular crisis. That's not at all what I'm trying to do here. What I'm trying to do is show you the science. So that being said, I've got so much new information. Last time on our COVID one files, we're going to say how we're going to talk about what you can do with lifestyle and supplements. We're still gonna do that. Absolutely. And I actually learned a lot from being on Chang Raun's summit. You can look that up. It's Raun, Chang Raun. Some of his experts are functional medicine experts that understand the supplements better than I do. And I took notes while I was there. And I was a panelist on that. And the stuff that I talked about was really well received by his panelists as well. So everything is a moving target right now. So this is going to be I'm calling it a mic dropping show. Because if I don't get too geeky, and that's your job, Eric makes sure that I don't go into the weeds and be a nerd because I am a nerd to the nth degree. Angie and I have been nerding out crazy, like hair, you know, like reading articles and your hair just stands up because you're like, oh my gosh, there's no way this is here. Nobody else is talking about this. So if I come across here, and you're like, I've never heard of this. I feel like this it's because you're not spending 12 hours a day with the...a beast like Angie and I. She's uploaded over 20,000 articles to our Mendeley account. So I remember Dave Asprey when I listened to one of his podcasts. He's like, let me log into my Mandalay. I'm like, I wonder if his Mendeley is as big as my Mendeley, which is a repository of journal articles. So I'm super excited to get into this show. So that's my initial thoughts. That was my ramble. And I will, I will have everything else will be scientific data from here on out.Well, let's go ahead and start there. So we last on episode one. Basically, we broke down the various aspects of what is coronavirus? How is it directly affecting and we even talked about the stresses on resources. But now on today's show, not only do we want to leave everyone kind of with an idea on what they can do to supplement their own diet and the day to day things that they could be doing to basically improve their immune system as well as basically weather the storm better. Well, let's get a little bit more into the science of what's been some of the more recent data that I know that you and Angie shared because we've we've had a lot of conversations between last show, you going and doing now virtual clinic, me going and having meetings on transitioning the ASC over to possibly new ICU rooms, which is something we've never had to do before. So I'll let you kind of take it away there.Yeah. So you know, this is this is daily. It's hourly changing, let's be honest, and this is a global problem. So there's so many studies coming in what I think that makes us a little bit unique on the gut check project, is what we're doing is we're looking at the the data being published right now. 2020, late March, everything's been published, but then because of trying to link it to the 2003 we are able to look at articles back then also, because the SARS COV-2 virus structurally is extremely similar to the SARS first virus the COV. So a lot of these articles are a transitioning like that, where you can say that this is this and then because of that the links allowed us to find other things. So, a lot of what I'm going to talk about is preprints, meaning that I have access to articles that aren't even in publication yet. But the scientists are so passionate about it, that they're just sending it out. A lot of it comes from China because they have the most experience. I believe that when we did our first COV files last week, I don't know what was their 160,000 cases, something like that. I don't remember.Yeah, they confirmed and that's that's a pretty important thing. So we talked about that last week to confirm just because we're increasing confirm number doesn't necessarily mean Doomsday. It's just that we're able to actually confirm that a number of people actually have it. However, it does become a data point that we need to reconcile with. And we will yeah, we can we can get into that. But I just want to tell you I just looked about an hour ago and right now, the confirmed cases are 577,495. Mm hmm. That has jumped a bunch. There has been 26,447 deaths. I'm getting a lot of emails from healthcare workers who, when these patients are funneled to one institution, like my hospital, that institution, those health care workers are putting themselves on the front line. They are, they are the heroes. They are defending all of us by taking care of this and I just want to say thank you to every healthcare worker that is working shiftwork, that is in hospital, because you are the frontline of this and many times you don't even know if the person you're treating has this extremely virulent virus virulent being very contagious. So thank you. Thank you. Thank you.Yeah, without question. Thank you. Now, I this is not a doomsday podcast at all. In fact, to the contrary, what this is going to be is a complete bright light on this whole viral pandemic. I feel like we have spent this whole time figuring or looking at data and piecing together things that will bring hope to everyone. And that's what this podcast is going to be: how do you actually protect yourself? This is based off science. This is based off a bench research. I understand that some doctors would say, well, we need a randomized placebo control trial. We are not in an era right now where we need to do that. I understand that that is ultimately what we want to do. But in this I just want to protect people with things that we know have been around a long time. It doesn't have a whole lot of downside. So I have a moral obligation to do this and to share it with everyone here.Definitely, without question.All right, so let's let's talk about transmission, some of the newest information that's been learned. So everybody if anybody's new to the show, if anybody's wondering like, Why in the world is gastroenterologist talking about COVID19? Well, everyone's talking about cobit 19. So, doesn't matter if you're human, you're talking about it, but it's actually specifically relevant to me. And some of the newest information is this is that we now realize that the virus can be passed both through droplets in your respiratory system, and it can infect your gastrointestinal system. As it turns out the h2 receptor that we believe the virus attaches to that most have agreed to that the highest concentration is in the stomach and the duodenum which is the first part of your small intestine. So if you are eating food, that somebody has cooked for you or that, or maybe you've well, somebody else has to have cooked it for you, and you eat it, the virus can then get into your body through your gut, we now realize that somewhere between 30 to 48% of the COVID19 cases are actually starting in the gut. And 85% of those present with anorexia, or they're just not hungry. What's fascinating is that when you and I were talking, and we were going over those numbers last week, I was like, why is that and then the very next day, articles have come out and it's made the news now, but we were talking about it last week, about how one of the early signs of this could be Anosmia, which is lack of smell, right? Ageusia which is lack of taste. So my theory is that those people that have that that precedes the symptoms by a long time, or not a long time, we don't really know but it certainly is one of the preceding symptoms. So when I'm walking into my hospital and they have to scan me and see if I have a fever, first question that I'm asking is, how's your sense of smell? Because that is now a screening tool. So keep that in mind. The letter there was a article published from my college, not my college, I went to but the American College of gastroenterology, which is the society that I belong to. There was a report from China reporting that cases with someone who had contact with her brother from Wu Han, so a woman shows up with a fever to a hospital. Her brother had come from Wu Han to stay with her. She gets a fever she shows up says my brother was in Wu Han. I've got this they do a CT on her. And she has the ground glass appearance of the classic COVID19Right.tested negative four times on the sputum. One of the doctors was savvy enough to go test her stool. They did an immediate polymerase chain reaction a PCR. Her stool is positive, her sputum was negative.So the sputum technically you're saying that they the margin, there was a she basically was a false negative, correct?She was a false negative on the swab that they did. They did a total once they got her diagnosed, they knew that they were dealing with COVID19. So then she became sort of a case study where they did like five more swabs on her all negative. So what we're what we're talking about here is that the gut so as a gastroenterologist, I'm telling everyone right now your gut is your first line of defense. And we need to protect that you can do all you can for barrier to avoid droplets to get it in your eyes, your nose and everything. But you still gotta eat and all these people that are ordering takeout and everything. somebody's preparing your food That's a route of admission. And then this is not to create anxiety. This is just so that everybody understands this. And then I found another study, shockingly, that showed that there was viral shedding in the stool. Five weeks after viral shedding in the lung went down. So they recovered from COVID19. And then a group of physicians tracked these patients and they kept checking their stool. Five weeks after being normal, they still had virus in their stool. And on the last show, we did talk about the fact that the virus can live three to four days on steel and plastic, it can live in the air for hours. So if you've got maybe what we're talking about here is fecal oral. And I hate to say that because everybody cringes when I say that, but that's how all gastrointestinal bugs get passed.Well, I think we should address it you know, you're talking about science to layman's terms. So If we're addressing things like, keep your six foot distance, etc, that has a lot to do with the droplet transmission. Everyone's been told and we've learned as children growing older that we should wash your hands after going to the bathroom. But specifically, if you're going to the bathroom and and you've, you've had a bowel movement and you certainly if you've known that you've had exposure to Coronavirus or COVID19 be certain to be diligent about washing your hands after you finish the bathroom, even more so than in the past. So if you've always been washing your hands great, it's now's the time to make certain that you're diligent in the process of washing your hands, keep your hands clean, because the fecal to oral transmission is a real, is a real problem.I got called by a doctor today who wanted my opinion. Very intelligent doctor and he was like, hey, man, what's going on with this? It's it's all hype, whatever and I I started telling him about this kind of stuff. I said, no, it's this is this is real. We all need to...education is the key to controlling your anxiety. Remember that we're not here to cause anxiety. What I'm trying to say is, the more you know about this, the more you can control it. And what what we're going to do is talk about how to protect your gastrointestinal tract. Yesterday in shavon saunas CBOE SOS summit, I discussed how unfortunately, my theory is that if you've got CBOE bacterial overgrowth, or any other gastrointestinal problem in your upper small bowel, you probably have a compromised tight junction that will allow easier penetration. So my job is to let's fortify your gut. Let's make sure that your gut is strong. So when somebody comes knocking, you don't open the door. That's all you have to think of it.Just a quick reset it when he says tight junction is being breached. He's basically talking about the barrier in your GI tract basically, it can become permeable allowing you to become more inflamed or, or ill. So basically he's saying if you have this issue, what we're trying to do is protect it so you don't have that problem.So you're gonna do this a lot for the rest of the show. Basically, I want to say things that because I have been so into the weeds reading just super sciency stufflike what he says when he says into the weeds, he means like he's going to drill it, no I'm just kidding.I just it's just rabbit hole after rabbit hole because you hear a term and you're like, oh my gosh, what is that gonna go down over here and this and that. Alright, so I'm just going to talk about one of the coolest things coming out of Germany is there are some scientists that have a new rapid test to diagnose SARS COV-2 remember SARS. COV-2 is the virus that causes COVID 19. SARS COV-2 is the coronavirus the coronavirus is a family of viruses, this is the ridiculously tough, virulent, you know, bad one that's creating this pandemic. So some brilliant scientists realized that certain flavonoids, or polyphenols have a very high affinity to attach to the SARS COV-2 spike proteins. So you always see that picture of the, of the of the virus they always had it shown with a bunch of those little spikes all over the place. That's how come, Eric, you told me this earlier that's why they call it the corona because it looks like aLooks like a sunburst. That's what it is. That's how I learned it long ago, but it was called Corona because microscopically It looks like a big, big sunburst.Yeah. So normally, the way that these tests are done to try and determine this, what they're talking about is a diffusion test or what's called an agglutination test, but what these researchers showed is that two polyphenols luteolin and quercetin have a very high affinity and an inhibitory effect on the SARS COV 2 virus, I'll say it again, basically natural products, natural molecules in nature have the ability to attach to the virus. And what these guys proposed is that normally, when you have a test like this, you have to have an antigen, which is a protein that the antibody has to buy into or in this case, what you would do is use a very expensive antibody against COV-2. So they're trying to do tests like this, but they're taking blood from people or animals, getting the antibody and then if you put your sample if the antibody attaches, then you know that you've got SARS COV-2. These cats figured out that natural polyphenols attached to it. So what they do is they put the sample in, they put some polyphenols, there luteolin and quercetin and then if it clumps, then they go, that's positive. If it doesn't, then it's just chilling. That's, that's mind blowing.Yeah. So essentially, what you're saying is, is these polyphenols made the SARS COV-2 virus nonreactive. The antibodies had no, they didn't discern it whatsoever. So it was a negative test.No. So what it is, is they didn't necessarily make them reactive or non reactive. All they did is they could show that they surrounded it and smothered it. So when they found this in clumps, they knew that they had SARS COV-2. So this is just a preliminary test to say do you have it or do you don't, you can extrapolate that it can be both diagnostic and therapeutic. Meaning you can look at this and say not only can you diagnose it, but there's a very good chance that this same type of polyphenol may treat the virus. And that's what these researchers basically said in their conclusion. And what's awesome is they said this could probably be done with a lot of other viruses because of the antiviral activity. Soit's very, very interesting diagnostic, I'm almost certain whether it's therapeutic or not remains to be seen. It certainly is a natural compound to, at a minimum run interference for the SARS COV-2 virus.Yes, so you're probably wondering, Well, why in the world did you bring up some obscure tests that isn't even out yet? Because what's awesome is, these are all like preprints. These are scientists sharing stuff around the world. And I can almost follow when one guy references another guy, and then they do a study. The studies that I'm going to talk about in the beginning are all bench research that is called in vitro. When we describe something in vivo it's one we give it to a human. Right now, the virus is so new the novel Coronavirus is so new, that everything has to be done in a lab first to see what could be potentially effective in a human. So keep that in mind because that's that's an argument that a lot of people will say is oh, well, there's no randomized placebo controlled trials on humans blah, blah, blah, we're not we're not we need to stop something first. Need to control this and then we can flatten the curve. Get that R0 watch this, watch the first episode because we get way into the R0 thing get that R0 down, and then we can go there. So, dude, what I'm going to talk about is absolutely nothing short of extraordinary, extraordinary. And these are drugs that President Trump is telling all these private companies. I think there's like last week there was 35 different companies trying to produce products against this. There's a lot of them are called protease inhibitors. A protease inhibitor is an antiviral drug that we, that got discovered during the HIV era, where what they do is they block the virus's ability to grow up. So in other words, a virus tries to release his buddy. And then the protease inhibitor says, nope you're gone, and then they kind of kill the new viruses being produced. This is, and this, this prevents the viral cells from growing and maturing. And according to the scientists that are looking at clinical trials, they're trying different protease inhibitors to block SARS COV-2. So there's clinical trials going on with protease inhibitors that we know So, the first article that I want to talk, this is the title of the article, and I will let you, layman for me. Okay. All right. This is the actual title of the article. It is a pre print article. So it should be what we're talking about here. When I say pre print is I'm giving you information before way before it's going to make the news way before. So this is why this is a hopeful podcast, very hopeful podcast. Potential inhibitor of COVID19 main protease empro, from several medicinal plant compounds by molecular docking study.Okay. Well, let's see, it sounds to me like what we're trying to do is use a naturally occurring substance, to eventually stop a virus.Through the protease inhibitor method,Well you said layman's terms last time my neighbor said protease was never. You're right. Yeah, yeah. You and I have different neighbors. My neighbors and I talk protease all the time. I'm surrounded. All my neighbors are infectious disease doctors. SoI know it. That's, that's what my takeaway is from that is, we are going to find how nature can allow mammals, humans to consume a natural compound and stop a virus from spreading.Yeah, so correct. So what they did is a researcher in China was able to successfully figure out or crystallized the COVID19 protease, that's the key step. And these guys took that person's science and said, okay, what is a potential target, to stop that protease? And they develop this very complex, cool study where they could show the binding energies. So when they say docking, the cell has to dock onto another cell. And then if it infiltrates, then if you give a protease inhibitor, it can't move. So they want to know how tight it binds to that protease enzyme. And what they figured out was they looked at three HIV protease inhibitors and 11 polyphenols.So and then just to reset into layman's terms, if you're trying to keep track of the the words, the way that I kind of have charted this together is a virus uses a protease like a key. The protease is the key for the virus to infiltrate and then deposit this mRNA so it can replicate what Dr. Brown is talking about doing is how can I stop their key from working? How can I make it so that this virus can can't use the key the protease to where the virus is using that protease to break down the protein so it can inject its RNA?Yeah. So the viruses, like we talked about before, are amazing parasites, they have to get into a cell, they have to replicate, they take over the cell, and then the virus starts going around. So these guys knew that there's three they looked at three HIV proteases. And then they realized that there's naturally occurring molecules in nature called polyphenols. And they demonstrated that the drugs and these 11 polyphenols appeared to have potent attachments to the M Pro with the M Pro is the protease on COVID19. Therefore preventing the virus from replicating their fin...their final conclusion was like all good bench researchers. Further research needed to do human trials.Sure.So they have a model with the virus and these polyphenols bond tightly. Super cool.Yeah, no without question. So essentially, they're saying if we can find a way to stop impro from unlocking the cell, then SARS COV2, or the coronavirus cannot infiltrate these cells.Yeah, so that was really cool. And then mic drop. Another study comes out of this one's out of Turkey and Pakistan. And I'm going to reach out to these researchers. They were kind enough to list their cell phones and emails on this study. I'm not sure that they meant to do that. Doesn't happen all the time!I'm gonna I'm gonna hit them up and I just gotta find somebody that can translate for me if necessary. We're going to do this. Their article title is identification of potent COVID19 main protease. Now you know what a main protease is empro. These guys took the research from the person that discovered it and did the exact same thing as these other guys did. So identification of potent COVID19 main protease inhibitors from natural polyphenols. And in silico, strategy unveils a hope against Corona. What? These guys saw that study and went, wait a minute polyphenols seem to be the way to go. This could be a new hope for Corona. This is what these guys are talking about. It's out of two very prestigious academic centers in Turkey and Pakistan. These guys are absolute beasts, I should say, guys, I'm just assuming there's probably women on the team also, that's rude of me to say these guys, but these scientists are beasts. So since its main protease was figured out, and remember I'll say it one more time, the protease allows the virus to grow and replicate. That is why we figured it out for AIDS. So they did a study where they looked at 26 polyphenols and one prescription protease inhibitor called nelfinavir. OkaySo these guys had the guts to say let's see what happens when we compare polyphenols to the current antiviral therapy that we use for AIDS. These results are absolutely shocking, Eric, this is I cannot make this stuff up. This is where my skin my hair just starts bristling. Basically 24 of the 26 polyphenols bound tighter to the COVID protease, then the prescription drug did. I'll say that one more time. It bound tighter than the drugs that we're thinking of using. Nice.And I'm really having a hard time trying to not be enthusiastic here and try to be scientific. I said it's gonna be very somber, scientific thing, but I'm just now um these are lab people. And these these guys, I could tell by the writing that their that excited I mean, when, when the title says, you know, exciting new treatment for Corona like these are bench researchers that if the numbers make sense. So this is not something to say that 100% this will work in humans, what we have is bench research stage one, stage two is to work to a human pilot trial, stage three is to do a randomized placebo control trial and so on. But this is so exciting to see that this is proven in a lab that these 24 out of 26 polyphenols and what this tells me is certain polyphenols did slightly better than others, as best they could tell. But the molecular mechanism is very similar it all is and then what they determined was it was a dose dependent, so you had to have enough of it to do it. So pretty wild.I don't want to jump too far ahead. But questions that are popping up in my mind are going to be number one is binding for the most part, preventing the virus from carrying out its activity. Because, you know, you don't want to just bind and be happy that you are bound, and the virus can go on. And the other question would be, what, what are the categories of polyphenols that happened to perform better than others? And do they all still you said 24 out of 26. So we know that two probably aren't ideal, but what were the categories?No, no. 24 out of 26 outperformed the prescription drug. The other two just were about at the level of the prescription drug.Thank you for the correction. So 26 bound.And I just want to clarify one thing I'm you and I are not virologists. The concept of protease I think, is more of a replication thing than a that's how come it works so well to stop the virus. I think it's more of a prevents the virus from replicating as far as binding. There's some different science with that. So just and I'm not a virologist, I'm a butt doctor. So um, so then of course that starts, you start going down some crazy pathways. I found another article that identified myricetin and scutellarein or something like that, which are polyphenols. Somebody else did a study as a novel chemical inhibitor of the SARS coronavirus. by blocking the helicase. The helicase was described as something needed to replicate. Yeah. So what I meant by I've just been exhausted is I read these articles and then of course, you stop. And it's like, I gotta go look that up. And then you end up going down a helicase pathway and I was just like, oh my gosh. The science doesn't matter. What I'm saying is there's people that are now looking in 2020, because they're doing the same thing I'm doing, they've seen the data from 2003. And now they're trying to see if that works on SARS COV2. And it appears it does.Well, is it a helicase? Isn't that an enzyme? Yeah, we hear about the double helix or whenever you see DNA after it's been scripted, and you see the winding, you know, mirrored image. Helicases, the enzyme that allows the assemblage of the mirrored DNA if I if I remember correctly, I could be wrong on that.So that is, that is med school year two USMLE. was done with that. As long as it passed. Um, here's another super I think I get pulled a gene like they pulled the gene out or something like that. Sorry, I don't wanna get sidetracked. I'm just kind of like...I don't know. I mean, dude, it's like clearly We're gonna have to get a virologist on to explain all the terms just say you guys are idiots. You're using the terms incorrectly. Let me explain it to you cool. I I welcome any virologist to to help us get through this because this isn't our thing. I'm trying to figure out how to take care of my patients. That's all I'm doing right now. Speaking of that. Another study titled small molecules targeting severe acute respiratory syndrome, human coronavirus. These guys looked at over 10,000 compounds, including over 500 protease inhibitors, 200 drugs, 8000 synthetic compounds and 1000 traditional Chinese herbs. Of all of them 50 were found to be anti SARS COV not COV2 anti SARS cubs. So this was a study done after the original SARS outbreak. Okay. Two made the best cut, one being a molecule called Aescin-AESCIN, the extract of horse chestnut.Horse chestnut. Yeah. Wow.And the other is a drug called reserpine which is a high blood pressure drug used in Europe. Huh 10,000 different compounds and Aescin the extract of horse chestnut is there. Okay, that's cool.Yeah, it's a polyphenol,that is a polyphenol/saponin. And we know a lot about that you can go on atrantil.com and learn about Aescin and if you want. Pretty wild. So that's my this is where this is going to go. We're going to be able to figure out how to optimize the appropriate polyphenols to protect your gut to protect your health. Those are astounding studies. It's I mean, I'm just fascinated. Alright, so everyone knows this. We developed atrantil. Atrantil are three polyphenols I have been into the science of polyphenols for over 10 years now. So now that I'm looking at this, this is not a sales pitch. This is a oh, my goodness, the molecule that I've been studying for 10 years, which is super complex and all this, I'm finding scientists around the world studying it and having positive results. That's what this is about. Nothing more.Now, here's here's the interesting part, though. So if it happened to only be a prescriptive drug or something that were synthetic, it would almost be completely imperative that that multiple rounds of trials and testing be carried out. Simply for the safety profiles so that they can be safely used somewhere. The exciting part to me is that what we're talking about is something that is already naturally occurring and is safe for us to begin to utilize as kind of like internal PPE. That's how I think about it as a frontline worker...Say what...say what PPE isOh sorry, personal protective equipment. So that was...Yeah, so one of the issues that if you're not in healthcare, the term PPE is being used because we're all running out of gowns, masks, gloves.Everyone is and it hasn't even hit our area nearly as intensely as it has like the northeast or the west coast, we're we're running outAnd you you as essentially, somebody who controls airways and you have to intubate people, you aren't so in the line of fire, so to speak, you're on you're that frontline person. You're one of those if you're an ICU nurse, if you're an anesthesiologist if you're a respiratory tech salute all of you, because you guys are right there getting into it. Now, some would say, hey, you spent the first half of the show talking about gastrointestinal issues. Yeah, I salute my gastrointestinal colleagues as well. Because it looks like we're in the fight now also.Definitely. It's just it's the takeaway, though, from those those studies, those reviews that you just had, though, Ken, don't you think that the exciting part on top of we think that we may be onto something is that people can begin to take action now with at least the data that is applicable, it's safe to use it worst and at the bare bones worst if someone happened to just simply start eating more polyphenols that they would take in from fruit yet, if it didn't work? Well. They're still getting great fruit and fiber etc. There's there's really no downside to applying a little bit of this, this reviewed science as we as we wait to find out that these are actual adversaries to the coronavirus. Correct. So polyphenols if somebody's like man they've been talking about polyphenols this whole time, what does that polyphenols are the molecules that make vegetables and fruit, colorful, it's on the skin. Those are the molecules found heavily in the Mediterranean diet. And those are the molecules that we now believe are anti aging anti inflammatory molecules. That's how come that we've been studying this so much. So I've been using it for gut health. So if at the very least, when you eat, make sure your plate is colorful, everything should be colorful. If you can imagine when you go to McDonald's and get your whatever it is. thing you lay it out. It's got a monochromatic tan across the...Very yellow...very yellow plate.Very yellow plate. You want to have green reds and purples and When you're doing that you're getting your polyphenols in knowing that the polyphenols could potentially help this. So that's super make sure that you at the very least do this. We know that they are very potent antioxidant, anti inflammatory antibacterial and antiviral. Yes. data to show all of that.Yeah, definitely. No, that's that's it's just a great takeaway to know that you can actually possibly be taking some serious action for your benefit and your family's benefit today.Yeah, totally. Um, so let's kind of get away from polyphenols and talk about what else you can do. But you're gonna hear a recurring theme here. It's, it's or fortunately, Mother Nature knows how to do this. And you got to take advantage of that. So let's talk about something so I've been getting tons of emails and patients calling in everything, what do I do for this and that, so let's talk about zinc. Why is everybody saying zinc? Why did they get buy get bought off the shelves? Why is it there? Well, zinc, if you're low, then your immune cells won't function well. And intracellular zinc can block the enzyme that allows the virus to replicate, which is an RNA polymerase enzyme. One more time, you take zinc in, very small percentage of it gets put into the cell, where the zinc then just goes, come on now, and they just starts working on the virus's rep replicating system. That's how it works as an immune product. And so zinc is an essential mineral that we need to take in, but you got to get it into the cell. So some scientists realize that we have to figure out how to get more zinc, intracellular. I got to quit touching my face, I just realized I'm messing up my hair and I...I've been doing it the whole time.Yeah, I'm realizing just I mean, I just get I get, I get excited about this. We know that zinc can inhibit, specifically Coronavirus, RNA polymerase activity in labs, but it has to be intracellular. The problem is that once it's in the cell, it can do that. But it has to get in there. And that's difficult to do. Scientists have realized and I keep saying scientists have realized I'm just referring to other smarter people that have done these studies is what I mean. So other people that are smarter than me have figured this out that it needs something called an ionophore to get in. So it's like a fast pass or it's a it's there's a security guard at the cell door, and zinc like a my humans eating all kinds of zinc. I'm here to help out and the security guards like you need to come in with somebody you need to have a VIP with you. Well, they're looking at different things that work as VIPs and as it turns out, flavonoids which are In the class of polyphenols, not only act as antioxidants, but appears in this particular study that they drove zinc into the cells, then they showed that with mice, they could actually show a rapid increase in intracellular zinc, when the zinc was taken with polyphenols, or if you're taking polyphenols. And also taking zinc doesn't have to be the same time. And they did this through very complex fluorescent staining. So that is super wild. You need zinc, but you need intracellular zinc. So really pretty, that one kind of blew me away also. So I just got done talking about two bench studies, where they work as protease inhibitors. And now I just showed you how polyphenols can work as zinc ionophores. That should be like enough, and we actually have more stuff to talk about, which is nuts. SoSo just in just a quick aside if if you have a diet that's comprised of good Healthy meats. What else? Beans probably seeds, nuts, various nuts. That's where you'll find naturally occurring zinc or...Cashews. Cashews are a big one.Definitely there's there but there are definitely some zinc supplements out there. So as a as Brown lays out different things that you probably could take at a molecular level, I'm going to try to keep up and say, places where you can find them so that you can incorporate them into your daily intake of foods.Yeah, so unfortunately, I'm just geeking out on this. So if you if you figure out how to say, Well, if somebody's sitting there going, Wow, where do I get it? Yes, absolutely. Thank you. Thank you for doing that. Um, something else. There was a study that came out of Korea, which showed that by certain probiotics in vitro, they could actually stop the hearing metabolism which this particular virus uses to get energy and one step further. That was in vitro then I found an article that showed that polyphenols work as an antioxidant by blocking xanthine oxidase which is part of the pureeing pathway. So the energy gets taken away from the virus as well. So that's super geeky. It's like, wow, it's like almost like every time somebody chooses to do a study on these polyphenols, they're finding a positive effect. We have gotten sicker since we have become industrialized, and we have refined foods. Having soil with rich and minerals and everything and eating the seasonal vegetables is probably a very effective way to protect yourself from a lot of illness. Not trying to say specifically COVID19 but doing that is probably a great way to protect yourself from a lot of things.Definitely hundred percent. I don't have a whole lot to add to that.Alright, so I'm tired of polyphenols, if I could ever say that I've only been talking about 'em for 10 years. So, alright. We did say on the first one that I want to give some recommendations about things that I'm telling my patients that I'm doing that my kids are doing that everyone that I think there's some science backing this. So other recommendations I'm telling I'm a big fan of fermented foods. I don't understand why but Germany continues to have this profound or I haven't, or a very a much lower death rate than the rest of the world. And I always laugh because I'm like, Is it the sauerkraut? I just keep coming back to them because the sauerkraut is it the beer. What is it, but so fermented foods, especially those that have Lactobacillus plantarum and bifidobacterium and lactobacillus generally will actually have been shown to have some antiviral activities. So now's the time to go out and get that kimchi now's the time to go out and eat that sauerkraut and that kind of thing. As you know, I'm not a huge fan of probiotics based on the science because not that it's there they're bad. But the science just isn't there and I don't want people spending a whole lot of money on things that don't work. I'm a big fan of polyphenol wrapped probiotics, kimchi, sauerkraut, things like that, because the insoluble cellulose, in my opinion probably works as a vehicle to get that bacteria to the colon. So, fermented foods. I'm kind of a fan of right now. We discussed zinc and vitamin C is an essential micronutrient that works as an antioxidant. What you will hear online right now and in forums is that studies in humans are extremely conflicting. So you have to go a little deeper than that. And that's the knee jerk that every doctor will say as well. The studies don't show that. I want to say this. Angie and I discovered an article with mice genetically grown, that do not have the capacity to make vitamin C. And then they took mice that are normal and they exposed...they exposed both groups to influenza, those without vitamin C died. Those who had it had a lot less inflammation and a lot less inflammatory cytokines. Right now in China there is an ongoing study where they're looking at giving IV vitamin C. So if you want to compare old studies that talk about the rhinovirus and does vitamin C help, what we know is looking at animal data, vitamin C is extremely important. And the reason why it's important is that we know it down regulates and inflammasome, inflammasome called NRLP. What that is, is we know that people are dying from what's called a cytokine storm, which is where your immune system overreacts to the virus. It starts with an inflammasome and then it becomes a domino effect. And just start turning on all these cytokines. So it also helps regenerate glutathione, which we're going to get into. And one of the only problems with vitamin C supplementation is if you take too much it can create some gi upset. When I was on Dr. Raun's summit, Dr. Lundqvist, who went on before me who's an expert in this did discuss something really cool, which I was unaware of when you are sick, you increase what's called your glute one receptors. So you will absorb more vitamin C that you take in, so your body knows when you're sick. So if you're not sick, and you're taking tons of it, you're probably gonna have some gi upset. If you're sick and you take a little extra, you'll probably be fine, which I thought was really cool. So I love learning from other really smart doctors. Next product everybody goes on vitamin D. Yes, we know that most people in the United States are vitamin d deficient in a systematic review, vitamin D appeared to protect individuals from acute respiratory infections. Vitamin D is expressed on both B and T cells, which are our immune cells. And what it does is it can modulate your immune response. I'll say that again, it can control your immune response. So it almost works more like a hormone in that it tells your body to not overreact, which is something super important. And low levels are associated with increased autoimmune disorders and increased infection rates. So looking at a different study, it looks like that taking high dose vitamin D on a weekly basis, which is what many doctors recommend, is not as effective in this particular case as taking a daily vitamin D supplement. So I would recommend somewhere around 1000 milligrams a day. Most supplements come in the 2500 to 5000 range but I'm on it and my family's on it as well. So super important to do thatThing here so vitamin D foods are lot of your oily fishes, dairy milk cheeses and I think some of the greens like collard greens and mustard greens I think have vitamin D and of course don't forget you need to convert it. Get sunlight, get sunlight every day.Yes, go out for walks. walk your dog Get out right now is a great time to get out. And yeah, thank you for saying this. I should have started with everything. I'm not saying get out. I should have started from the very beginning. Don't go out and buy a bunch of supplements. Try to eat the diet that has these ingredients in them first. Supplements supplement a healthy lifestyle, but is no substitute a healthy lifestyle. So that being said, Yeah, so thank you for bringing up those foods. And I will throw this at you now. A diet in healthy phytosterols. Phytosterols are vegetable oils that appear that they may block the binding site of these different Coronaviruses. In other words, the ACE-2 receptor that they keep talking about in the news uses cholesterol to bind to what is called a lipid raft and then that lipid raft of the virus binds to it and then it kind of slides down. I always think of it like the way that they describe those inflatable rafts when a plane lands on the water they come out and people come out that's how I think of it.Don't you want to get into a situation where nobody gets hurt but you get to pull it I always wanted to inflate that stinking thing.So a diet high in phytosterols. So things like you know what I'm gonna beat you to this one because I had that I actually had to look this up phytosterols isn't something phytosterols are very high nuts, legumes, grains and fruits and vegetables. It's a common theme here. We keep saying the same thing over and over. I mean, don't eat at McDonald's, eat your fruits and veggies, and healthy fish and things like that. And two more. And then this is this rounds out my list of science backed supplements that I can, I can at least lean on some data. Because there's a lot of things out there that people talk about. That is not my specialty is not my that I have not had a chance to get into. But n-acetylcysteine is something that I'm a big fan of, n-acetylcysteine (NAC) has some mucolytic properties. And in a 2017 meta analysis, meaning in 2017, they took all these studies, they found that treating patients with NAC NAC and n-acetylcysteine led to shorter duration of ICU stays in acute respiratory distress syndrome, which you geeked out on on the first episode explaining all about ARGS. So go back and watch the first episode because this is Eric's specialty, keeping people alive with that kind of problem. So salute to you for doing that kind of stuff. And Chinese protocols right now Chinese hospitals are using n-acetylcysteine as standard treatment when somebody comes in with coronavirus. It also does something really cool it increases glutathione levels. Glutathione is one of the most important cellular antioxidants. So what that does is it is a potent cellular antioxidant, and we need this for cellular health, cellular health kind of funny the guy that went on after me was Dr. Dan Pompa, who I who I love and his his whole his whole mission is cellular health, which is cool. A study looked at people with community acquired pneumonia, and they randomized them to either conventional treatment which would be antibiotics, and...conventional treatment antibiotics plus NAC. And what it showed was the NAC group healed quicker and had lower inflammatory markers. I'm currently taking like 600 milligrams BID, the dosages were all over the map in all these studies, but wow, okay. There's studies out here that show this and they essentially are you and I have talked about how NAC helps with alcohol metabolism, but this is a whole separate method. This is getting the glutathione and then ultimately, I'm recommending melatonin as well. Melatonin is a potent antioxidant. But one of the reasons is to make sure that you have everything functioning well. You got to sleep. During these very stressful times. You've got to get...try get eight hours of sleep. Please, please, please, please, please. And this is nuts. Kids don't seem to be affected by this virus and one of the speculative things is that kids have much higher melatonin than adults as we age we decrease our melatonin so over the age of 70 you have much less melatonin. I read an article describing how the higher melatonin that you have you in your NLRP3 inflammasome. inflammasome yeah.Is down regulated by melatoninNice.You have your highest melatonin traditionally between ages one and five. And as we age it decreases and if you do not have a high melatonin you are susceptible to a cytokine storm cytokine storm as we talked about is your body overreacting. So one last time did you write those all down Eric? Can you...I did.Tell everybody what what what I feel science backed things may help during this pandemic,In addition to a healthy diet of polyphenols or supplementation with polyphenols and of course we know where you can get that with Atrantil. There is strong science to suggest that you should couple a polyphenol diet with zinc, vitamin C, NAC or n-acetylcysteine, vitamin D, phytosterols, and melatonin. You can get zinc and NAC from meat, eggs, etc. Your vitamin C obviously comes from great citrus fruits and vegetables. Let's see here phytosterols there's tons of plants and seeds that have that in it and of course, if you don't produce enough melatonin that is a very common supplement. However, I will say though, that you want to be selective on probably where you where you buy melatonin that seems to be one of those. Oh yeah, yeah we that's a whole separate show. I actually pay to belong to examine.com and consumer labs.com. I'm a user because I go there and I have them do the analysis. That's a third party analysis. So any of these supplements make sure that they're third party analyzed. So those are the ones that I can sink my teeth into really deep and go, this clearly looks like this. Now, there's other things that a lot of other people will be like, oh, well, what about this? What about this? What about that? I'd like for instance, broccoli, broccoli, or sulforaphane? Sulforaphane comes in broccoli sprouts. I found some articles that show that coronavirus may decrease your NRF two pathway which is the pathway that leads to inflammation and that so I'm also taking that we know that that actually has some antibacterial effects. Shivan and I got kind of deep into it yesterday in the CBOE summit, where we talked about how I'm using that in my CBOE people as well. I'm having pretty good results. So that would be one that I can't really say, I've looked at the science, but I'm seeing anecdotal evidence and it's probably good for you anyways. So if it has some ability to help with this infection, that would be awesome. And we know that like, CBD attenuates the immune system, so it at least gets you back to balanced immune and neurologic systems. So I'm obviously a big fan of that. And that's you can go to our website and take a look there. I'm not saying not recommending it, that this is any type of cure treatment or benefit to this particular pandemic. I'm recommending to make sure that you're doing everything you can to try and improve your immune system.Definitely, if you're if you're a frontline health care worker, just be certain that you're doing all you can to take in a good diet. Be certain to get your exercise and know that you're probably hustling all over the hospital floor or OR just taking care of patients even if they don't happen to be COVID patients. You want to be certain that you're keeping yourself nice and healthy in that environment, get sleep, no matter what just prioritize sleep, your immune system just will never be as strong as it possibly can if your body is not getting rest, so sunlight, sleep in addition to a good diet, it will make for a much better outcome in the long run for certain.Definitely, we and we won't stop these installments for the COVID talks until we we more or less feel comfortable that we're heading that direction. I will say that we've been put in contact with an infectious disease doctor in the Department of Defense that actually he probably can't join us live or recorded on the next installment of of the COVID file. However, he is going to vet some questions that Dr. Brown has sent his way. Basically just just read his responses back. Yeah, absolutely. And we want to, once again, thank everyone who's worked in the hospital systems working, shift work, or EMS people. You guys are the true heroes because you are doing shift work you affect your sleep cycles, you're getting a lot of stress. I know I've talked to some emergency room physicians who are seeing other issues with this shut-in like, unfortunately some more domestic abuse going on and things like that because people are forced to being you know, the finances are tight, and the the quarters are tight and everybody is you know, struggling but hang in there. We're gonna get through this and what I just got done telling you even if you even if you're sitting there like it's been like what I like turning it because you guys like to joke around what do you do? I was just nerdy. Just bottom line is, it looks like we're heading in the right direction for figuring out how to how to stop this.That's perfect.Got a little bit different perspective as an ID doc, as well as tending to the pediatric side in combination with ID. That said, though, it probably won't be a full week until we come back with the next installment simply because we're finding some more time to dedicate collecting research and kind of really getting it organized. We certainly appreciate everyone sharing the last installment. Hopefully, we'll do the same here. And when the show notes for this one on the YouTube YouTube presentation, we'll be sure and list all of the supplement lists that that Ken laid out for you. And I don't know, it's a pretty powerful episode. I hope that people can begin to arm themselves and I think that the next time we're going to have some some good feedback and start rounding the corner to better days.Yeah, yeah, definitely. Well, appreciate everyone tuning in. appreciate everyone staying home. It is real. We still have to practice at least right now. What's the you know we're in March. We're still practicing social distancing.I almost forgot and I'll put this in show notes also, if you're looking to just make a difference in your community, Ron Lynch is a really close friend of Dr. Brown and I his name as name is Ron Lynch. He just started intellihelp about a week ago or a week and a half ago and intellihelp and intellihelp.org IntelahelpHelp. HELP. Intellihelp can be founded intellihelp.org. And intellihelp is intellihelp on Facebook. What it does, it's a very free service if you are available to give and help in service in any way. They've done really, really well over the last almost 10 or 15 days of if a woman needs diapers to take care of her kiddos and she doesn't want to leave the house. She just basically posts it someone who happens to be coming back from grocery store drops it off someone that kiddo needs to have an availability to have a free lunch dropped off because they're not getting lunches from school. Yeah, intellihelp is there to serve those people and to give you the ability to give back to them and trust me, if you feel a little bit down in the dumps, you'll feel a lot better once you're able to help somebody else and you feel like that you're notThat's awesome. That's awesome. So how do we prevent like a you know, our partner Mike Logsdon from gettin' on Intellihelp said I need a Guiness delivered to my house right now.There's no way to prevent that from happening because because Mike may need that Mike may need that Guiness. That is true. I have a feeling that as close as you live once you get on intellihelp Ken you'll be...Loyda goes where are you goin'? Mike needs his Guiness again.There's nothing I can do. I'm going to drop off some diapers and some can some some black aluminum cans at Mike's house.Yes. I love that. Awesome. Well, Ron Lynch, kudos to you. That is badass. Awesome. Thank you for being part of the solution.Definitely, definitely. All right. Well, I think that's the the end of second summit will be like I said it won't be a week until we get the third in. And we'll get a little bit more regular, a little bit more frequent as more news evolves. We're just kind of setting the stage here. But yeah,And if everyone can just comment, and let me know if you want it this sciency not so sciency. I mean, we're, we're, we're all learning as we go during this, because the because everything's coming out by the hour. Yeah. And we have the ability to go as deep as you want. We have the ability to find stuff that is not in print yet. And that's what I like when we're talking about stuff. And then three weeks later, the news we were talking about the anazmio well before it even made the news.Yeah. Well wondering if it was true, right. Remember that you said have read this. I have no idea if this is even accurate. I mean, between that and people shoving hair dryers up their nose, we didn't know which direction to go.True. Heat up the nose. That's right.Don't do that. It's terrific idea. All right. Well, ladies and gentlemen, thank y'all so much for tuning in and sharing a next installment here rather soon and they may not all be nearly this long, we may have some shorter...How long was this?Right in an hour? What? Yeah.It felt like 10 minutes.It's just a lot of info. Well, thank you Ken and, Paul, thanks for of course for putting everything together. We will see y'all next time on next COVID installment. I'm Eric Gregor. That's Dr. Ken Brown here with a gut check project. We will see y'all next time.Stay safe, everybody.

A Biblical Look at Aging (Part 1) - Howard HendricksA Biblical Look at Aging (Part 2) - Howard HendricksFamilyLife Today® Radio TranscriptReferences to conferences, resources, or other special promotions may be obsolete. What is Retirement?Day 2 of 2 Guest:                            Dr. Howard Hendricks From the Series:         What is Retirement?________________________________________________________________ Bob:                Pastor Rick Warren has referred to life as a dress rehearsal for eternity.  Howard Hendricks says that's a perspective we need to maintain even in our retirement years. Howard:         C.S. Lewis said it – "Hope means a continual looking forward to the eternal world."  It does not mean that we are to leave the present world as it is.  If you read history, you will find that the Christians who did most for the present world were just those who thought most of the next world.  It is since Christians have largely ceased to think of the other world that they have become so ineffective in this world. Bob:                This is FamilyLife Today for Wednesday, January 19th.  Our host is the president of FamilyLife, Dennis Rainey, and I'm Bob Lepine.  There is still a lot of eternal work that needs to be done, even in the retirement years.                         And welcome to FamilyLife Today, thanks for joining us on the Wednesday edition.  I know there's still a few years before you and Barbara hit 65, but … Dennis:          Yes, I was thinking about you, too.  Are you and Mary Ann ready for retirement? Bob:                We're still – we're much younger than you. Dennis:          I was thinking, have you thought about early retirement? Bob:                Are you trying to suggest something?  Pick up your check on the way out the door? Dennis:          You know, there are some people who, if they heard that, and you know I'm kidding 100 percent, but if they heard those words, that would be chilling words – to hear your boss say, "Have you ever thought about early retirement?"  And the reason is, they don't know what they'd do, because they're not sure what they're about today.  And I think, as never before, we, as followers of Christ, need to be on a mission that transcends what we do at work. Bob:                That's right.  We're listening this week to a message from Dr. Howard Hendricks, who spoke to the couples who speak at the FamilyLife Weekend to Remember conferences.  We asked him to come in and help us think ahead to that time as we grow older when we'll face retirement, and we've got some young couples who speak at our conferences – couples in their late 20s and their 30s, but they were taking notes just like everyone else was taking notes, as Dr. Hendricks laid out a game plan for us to think ahead to that time when we may slow down a bit, because our body does slow down; when we may have less vocational work to do.  But it's not a time to just sit on the porch and rock.  It's a time to have a new focus and a new mission. Dennis:          It is, and this message is a part of a three-message series we're offering here on FamilyLife Today on the whole aspect of growing old and thinking through the aging process biblically, and I think there is a need for us to do that.                         Dr. Howard Hendricks was my professor at Dallas Theological Seminary where he's taught for over 52 years.  Now, think about that – he's had a job there for a long time.  He is still teaching there.  He and his wife Jeanne have four children.  I think they have eight grandchildren, and he is a great man and a great friend. Bob:                Well, let's listen together.  Here is part two of Dr. Hendricks' message on getting ready for retirement.   [audio clip] Howard:         I'd like to share with you five principles, but I want to underscore for you every one of them has a danger inherent in it.  Number one, retirement requires intensive prayer and planning and preparation.  It is hard to come up with the statistics, but if you talk to people who are specialists in the field of geriatrics, they will tell you this is virtually nonexistent, and I would say, "Well, maybe that's just true of the pagan community and culture."  I could only wish it were true.                           I spend all of my time in the Christian community, and I'm here to tell you the preparation is in the algebraic minus quantity.  There is a passage of Scripture that I hear, in my judgment, perverted.  It's found in the Book of James, chapter 4 – now, listen, you who say today or tomorrow we will go to this or that city, spend a time, a year, there, carry on business and make money.  Why, you don't even know what will happen tomorrow.  What is your life?  Here is the key – your life is a mist that appears for a little while and then vanishes.  You've got a little slice of life in which to make your impact for Christ, and often this is said to be a prohibition against planning – nothing further from the biblical truth.  Look at the last part – instead, here is your option, you ought to say if it is the Lord's will, you will live and do this or that.  As it is, you boast and brag and all such boasting is evil.  Anyone, then, who knows the good he ought to do and doesn't do it, sins.  What an indictment.  Not of lack of planning but of planning with presumption that I'm going to do this or that in my retirement and that is guaranteed and no thought of the will of God.                         That's why I say you need to begin by discarding the secular concept of retirement that prevails in your culture, and you need to replace it with the understanding it's not what do I want for my retirement – what does the Lord of my life want for my retirement?  How does He want me to spend those bonus years, which are priceless?  And planning, I am discovering, is a form of spiritual discipline.  Most of us don't plan to fail, we fail to plan, and that's particularly true in the area of retirement.  What's the danger in this?  The danger is the danger of unrealistic expectations.  They're either false or they're shifting or they do not exist and, in any case, they are lethal.                           The second principle I would share with you is this – retirement is always, always built on your personal mission, your calling.  And that's why it's not more productive.  To be productive and rewarding, your retirement must be meaningful to you in your stage of life.  That's why you constantly need to ask the question I hope you have asked prior to this – why did God place me on the planet?  I told you I am a fulfilled human being because thank God for mentors who so built into my life that they helped me to determine early on what was my passion, what was my gift?  And if I do not teach, then I cease having any reason for existence.  And so people constantly ask me, "What are you going to do when you retire?"  I said, "You've got to be kidding.  I'm going to continue to do what I'm doing right now and have been for over 51 years at the seminary and prior to that in a pastorate, and that's building into the life of other people."  But what happens if I become incapacitated?  I can no longer travel, no longer move, no longer speak?  Then I will spend those remaining years praying for those like you that God has left on the planet to fulfill the mission He has given you. What's the danger in the second principle?  It's the danger of allowing your life to turn inward; to become self-absorbed and provincial, and I must tell you, nothing breaks my heart as much.  I said as I did not too long ago with a man who could not control his crying by telling me, "I wasted my life," when everybody in our community celebrates him as the ultimately successful.  Now he spends all of his time with his press clippings, all of his time looking at those awards that he received, but he has no external impact except that which is negative. Number three – retirement revolves around your self-identity and, remember, your self-identity is being continually formed through the whole of your life.  By the way, if you have not learned that you are not indispensable, retirement will teach you that as nothing else.  Like a businessman said to me recently – he said, "Hendricks, I woke up one day after the party, after the celebration, and in the first month I discovered no one ever called me.  I spent all of my time and my life on the phone giving counsel, recommending what others ought to do, and nobody" – and so I decided I'd go down to the office to see, and I said, "How's it going?"  "It is going fantastic.  It's never been this good."  And he said, "I climbed into my car, and I couldn't drive, because I couldn't see.  And suddenly it dawned on me, I'm not indispensable, I never have been." We need to learn to distinguish between our work and our worth.  What you are as a person is not to be equated with what you do.  My friend, you are not a human doing, you are a human being, and our worth ultimately as Christian is what we are in Christ.  The danger is that that image is distorted by other people, and so you depend on what you need, and that's strokes.  But if that's your only dependence, you're in trouble. The fourth one – retirement involves a definite process, and it can easily be summarized in three words – there is a losing, there is a leaving, and there is a letting go.  If you fail to do any of the three, you're in deep trouble.  See, loss is important to all of life.  A number of us were talking before, many of them my students here, and they said, "Prof, what have you lost?"  I said, "How many hours do you have?  Jeanne and I lost our oldest daughter.  You expect to bury your parents, you don't expect to bury your children.  Try that.  We lost my youngest son's wife from breast cancer after seven years of incredible agony, leaving three wonderful kids without a mom."  And in the process of discussion, I said, "You guys need to know I have not lost anything of my drive, of my passion, but I've lost some of my energy.  I no longer can do what I used to do.  Try adjusting to that."  And it's hard for some of you, because you're not there yet, though some of you are moving in that direction and are beginning to see there are losses to life, and your task is to leave them, to let them go.  Otherwise, you cling tenaciously to them, and that's what eats your lunch in retirement.  That's why older people spend so much time in nostalgia.  It's not simply a desire to return to the past, it's a failure to face the future.  The danger in retirement is inertia.  It's passivity.  It's people who just sit, and if they think at all, all they can think of is their past. Number five – retirement demands an eternal perspective.  It was my little brother at Wheaton, Jim Elliott, who used to say it so often when we would meet – "Howie, we must give what we cannot keep in order to gain what we cannot lose."  So as a Christian you are forced to give up in order to gain what I believe may be the most significant years of your life from God's perspective.  But the ultimate question in an eternal perspective is what is the center of your life around which everything else is organized?  Is it a terminating core or is it a non-terminating core?  Whenever you build your life around a terminating core, whether it's your home or your car or your money or even your family, then you are going to sustain the most severe losses, and it will never fulfill you.  That's why the only adequate candidate, in my judgment, is Jesus Christ, the same yesterday, today, and forever.  This is why I believe hope is unique to Christianity.   C.S. Lewis said it – "Hope means a continual looking forward to the eternal world."  It does not mean that we are to leave the present world as it is.  If you read history, you will find that the Christians who did most for the present world were just those who thought most of the next world.  It is since Christians have largely ceased to think of the other world that they have become so ineffective in this one.  Aim at heaven, and you will get earth thrown in – aim at earth, and you will get neither.   When I was a kid, I cannot tell you how many times I heard the statement from pastors and Bible teachers and friends, and that is, "You spend so much time thinking about the next world, that you are no good in this one."  Do you know what we need to do?  We need to reverse that.  We spend so much time in this world, and perhaps this is why we are no more effective in terms of the next one.  What's the danger?  The danger is forgetting where your home is.   Malcolm Muggeridge, in his penetrating way, said "The only ultimate disaster that can befall us as Christians is to feel ourselves to be at home here on earth.  As long as we are aliens, we cannot forget our true homeland." [end audio clip] Bob:                That's Dr. Howard Hendricks, and I remember as he was presenting this material, sitting there thinking of that song, "This world is not my home, I'm just a-passing through."  Do you remember that one?  That's the reality.  We've got to keep our eyes focused on where we're headed, and we've got to do all we can in this life to get ourselves and everyone else we know ready for the next one. Dennis:          Yes, and his last point – retirement demands an eternal perspective.  It is all about investing in people.  It's about seeing God use us to change people's lives, and that's why, as we talk about retirement, what ought to be the prime time of our lives, I'm challenging on an increasing basis, in fact, I'm getting on my soapbox, Bob, and I'm challenging folks who are moving into these years of their lives – become a Homebuilder.  Lead a small-group Bible study with a group of married couples, a group of parents, maybe parents of young children or parents of teenagers, maybe the military family.  You know, this is a critical time for our military.  The family has been impacted there.  We have a Homebuilder Bible study that was written just for the military family. Bob:                We've got one for blended families, too.  We've got a whole series for parents and 10 different titles for married couples.  So we've tried to provide an easy-to-use tool.  Now we just need folks who will pick up the tool and go to work. Dennis:          Right.  I personally believe this Bible study is the most effective small-group Bible study for the family that's ever been produced, and you need to know when you support us financially, you make it possible for us to produce these Bible studies and get them translated and published in other languages.  And I want you, as a listener, to know that Homebuilders has now been translated into 200 different languages and dialects around the world.  We have no idea how many millions of copies have been produced and are now in use in other countries.  This is a phenomenal outreach, but it's a very important outreach here in America, and I think anyone who is approaching the retirement years ought to think about leading a Homebuilders' group. Bob:                That's right. We appreciate those of you who do support us and help make this outreach possible, and those of you who would like to become Homebuilders leaders, go to our website at FamilyLife.com.  There's more information available there, or give us a call at 1-800-FLTODAY.  Someone on our team can let you know how easy it is to start a Homebuilders group.  Again, our website is FamilyLife.com or the number 1-800-FLTODAY.  That's also how you would get hold of the message you've heard today from Dr. Howard Hendricks.  It's part of a three-CD or three-cassette series on the subject of aging, and you can contact us for more information on how you can have his messages sent to you. Dennis:          Like I mentioned earlier, Bob, get three copies – one for yourself, one for your parents, and one for your in-laws.  I think we need to be seeding the marketplace – those who are in their retirement years with good, solid, biblical teaching about what it means to age and grow old with a mission. Bob:                Well, again, you can find information online at FamilyLife.com or give us a call at 1-800-F-as-in-family, L-as-in-life, and then the word TODAY.                         Well, tomorrow we're going to introduce you to some college students who, back when they were in high school, decided to get together and make a movie – I mean a real movie – and we'll meet the woman who directed the effort and helped them make their dream possible.  We'll hear about the movie, "Holly's Story," tomorrow, and I hope you can be with us for that.                         I want to thank our engineer today, Keith Lynch, and our entire broadcast production team.  On behalf of our host, Dennis Rainey, I'm Bob Lepine.  We'll see you back tomorrow for another edition of FamilyLife Today.                          FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ.  ________________________________________________________________ We are so happy to provide these transcripts to you.  However, there is a cost to transcribe, create, and produce them for our website.  If you've benefited from the broadcast transcripts, would   you consider donating today to help defray the costs?         Copyright © FamilyLife.  All rights reserved. www.FamilyLife.com

A Biblical Look at Aging (Part 1) - Howard HendricksA Biblical Look at Aging (Part 2) - Howard HendricksFamilyLife Today® Radio TranscriptReferences to conferences, resources, or other special promotions may be obsolete. What Retirement is NOTDay 1 of 2 Guest:                           Dr. Howard Hendricks From the Series:         What Retirement is NOT________________________________________________________________ Bob:                There are challenges associated with moving into the retirement years.  Many of us have never thought that far ahead.  Here is Dr. Howard Hendricks. Howard:         Retirement has four major problems attached to it, the first of which is income – the financial component; the second of which is health – the physical component; the third of which is housing – your living arrangements; but the fourth and the most important is purpose, meaning, an interest in life.  And the fascinating thing to me, and all of the research proves it, is we're making tremendous progress in the first three, but substantially none in the fourth, because it's the least recognized, and it's the most neglected. Bob:                This is FamilyLife Today for Tuesday, January 18th.  Our host is the president of FamilyLife, Dennis Rainey, and I'm Bob Lepine.  Have you started yet thinking about your purpose and your plan for your retirement years?  Stay tuned.                         And welcome to FamilyLife Today, thanks for joining us on the Tuesday edition.  Whenever you hear that voice, whenever you hear Howard Hendricks' voice, you've just got to get a big grin on your face, don't you? Dennis:          I do, and the reason is he's one of those men who has marked my life over the past – well, I go back all the way to 1970 when I first started slipping into his class as a college student and then as a new staff member on Campus Crusade for Christ staff.  I'd slip in the back of the class at Dallas Seminary … Bob:                You mean you weren't enrolled or anything?  You just snuck in and listened to what he was … Dennis:          Shhhhhh – they'll probably want to charge me.  They got my tuition later on. Bob:                You enrolled, and you took – you said you majored in Hendricks. Dennis:          I majored in Hendricks and got everything he taught in one year, and, folks, if you have ever had a great teacher, you know that great teachers can really mark your life, whether it's a coach, a professor, a Sunday school teacher – they really can impact you.  And Dr. Howard Hendricks who was, for a number of years, the professor of Christian education at Dallas Theological Seminary in Dallas, Texas – "Prof" as he was known – really is – he was the finest teacher I've ever sat under, but he was more than just a professor.  He was a man who understood how to motivate men and women. Bob:                Do you remember what it was the first time you heard him teach where you said, "I want to hear more?"  He's a compelling speaker, he's very winsome, but there must have been something about what he was saying or the way he was expressing himself that caused you to go, "This is a man I want to hear more from.  I want to learn and grow." Dennis:          He had the goods.  In all my years at Dallas Seminary, I took five classes from him – not a boring class.  Now, I want folks to think about that – that's a lot of classes.  He was on the edge; he had the message; his wife authenticated his message; and he knew how to challenge and motivate young men who sat in those classes back then; now, young ladies as well, are being motivated by him.                         But he became a good friend.  In fact, we were just laughing the other day when I did a conference with him, and it's one of the great honors of my 34 years of ministry to have teamed up with him now on a couple of occasions for some conferences for Dallas Seminary.  But we were just talking at one of those conferences – I set a record for the most number of laymen brought to his class when I was a student.  I'd bring them in from the highways and the byways and the hedges. Bob:                So you used to sneak in and then, once you enrolled, you started sneaking other guys in? Dennis:          I brought other guys in.  I want to show you how to drink water from a fire hydrant, and Dr. Hendricks is, indeed, a fire hydrant.  And you and I both know, I ran across a series of messages that I'd never heard him give.  It was actually a lectureship sponsored by Dallas Seminary a number of years ago on aging.  And I first said, "You know what?  I want our speaker team that speaks at our Weekend to Remember Marriage Conferences to hear this series," and then I thought, "You know what?  I want you, as a listener, to hear this."  Because I don't think most of us have a very good perspective about aging and retirement and some of the issues we're going to face as we grow older. Bob:                Now, listen, some of our listeners are in their 30s.  Do you think this is going to apply to them? Dennis:          Oh, absolutely.  You know, in fact, if you go to the book of Ecclesiastes, I think it's chapter 12, the author says, "Remember God in the days of your youth," and then he goes on to describe old age.  It's kind of like, now wait a second, you're talking about old age, but why do you exhort us to remember God when we're young?  Well, I think the answer is your understanding of walking with God today as you're young will determine who you become when you're an elderly man, an elderly woman.  And I'm kind of on a little bit of a crusade and a soapbox about wiping out crotchety, gripey, complaining old men and bitter old ladies.  You know, I think we've got enough of them.  I think if anybody ought to have a smile on their face, it ought to be those of us who grow old with Jesus Christ. Bob:                Well, this week, we're going to hear one of the three messages that Dr. Hendricks shared with the FamilyLife Weekend to Remember conference speaker team on the subject of aging, and he was really talking about retirement, which he says is not a biblical concept in the way that most people think about retirement.  Let's listen together.  Here is Dr. Howard Hendricks. [audio clip] Howard:         I want to talk on rethinking retirement – one of the greatest transitions in human experience.  Norman Cousins said it – "Retirement supposed to be a chance to join the winners' circle, has turned out more dangerous than automobiles and LSD.  It is the chance to do everything that leads to nothing.  It is the gleaming brass ring that unhorses the rider.  For many people, retirement is an assignment to no man's land, grossly ill-fitted for Christian culture.  We are producing men and women, a society of unemployed people without a mission, the equivalent of a death sentence."                         It is proven by statistics – we now know that the average person dies within seven years after retirement and increasingly that figure is being changed because it is not uncommon for people to die two years after retirement, and the reason is clear.  There are two lines in every person's life.  There is a lifeline, and there is a purpose line, and the moment the purpose line evaporates, it is just a question of time before the lifeline goes as well.                         Bear in mind that retirement is a recent social phenomenon – the arbitrary age of 65 was set in 1889 by German Chancellor Bismarck, but what has always fascinated me is at that time in history the life expectancy was 55.  So the bulk of the people for whom it was designed never enjoyed the benefits.  And increasing it, as the United States has done, is just as ridiculous.                           Every now and then I hear someone say retirement is not a biblical concept, and it's quite transparent to anyone who knows the Scriptures that it is not the pattern for a born-again, eternally headed individual.  But it's only partially true.  We do have one reference to retirement in the Scripture, and it's found in Numbers 8, verses 25 and 26, where we are informed that the Levites were to retire at age 50; the reason being the task was so arduous, so strenuous that men in the intelligence which God alone provided, said you need to give up the physical ministry of the priesthood.  But what is often overlooked is that He gave them an option.  He said, "I want you to spend the rest of your life mentoring younger priests."                         Now, you may retire from a job.  You may not have the option.  But you never retire from life; you never retire from a ministry.  Stepping into retirement is stepping into entirely different universe with a distinctive lifestyle all of its own.  And I am convinced that this particular transition is, to the believer, one of the highest measurements of your spiritual maturity.                         So today I want to move into two areas.  First of all, examine retirement negatively – what it is not; and then, positively, what it is.   Let's begin with the power of negative thinking, with apologies to Norman Vincent Peale.  I find Peale appalling and Paul appealing.  The more I am exposed to the Christian community, the more I am convinced that some of the sloppiest thinking in all of time totally infects Christians who move into retirement.  So let me give you seven things retirement is not.                         First of all, it is not a reward.  Your reward comes in heaven not on earth.  But many people think it's a reward for good behavior, and the result is they spend their years sliding for home, reaching for the bench at the very time they ought to be tearing the place apart for Jesus Christ. Secondly, it's not a formula.  There is no one-size-fits-all retirement available.  It's a process, but it's a process that is highly individual.  There is no contract that spells out the details and the conditions.  There is no blueprint showing you the way.   Third, retirement is not a retreat.  As a matter of fact, it is exactly the opposite – it is intentional advance, but the key is it involves a gradual adjustment. Number four, it is not, not busy work – something to give you something to do.  It's a balance between leisure and work.  Isn't it amazing how often we suffer from the peril of the pendulum?  We swing to one side or the other.  Throughout our life, we constantly face the danger of worshipping work as an idol, but now we worship leisure as an idol.  And is it any wonder that John finishes an epistle by saying, "Keep yourself from idols."  Number five, it is not self-centered; it's not socially pigging out getting lost in an entertainment glut.  Retirement is meant to be more than for my benefit, and I think that's why an increasing number, even of secular people, are retiring from retirement.  The one positive thing about the baby boom is they live long enough and watched enough older people waste the latter years of their life that they are refusing to go that route.  They are asking for more time for employment where at least it gives them worthwhile to do.  Six, retirement is not guaranteed.  There is no guarantee that those latter years of your life will be successful.  They are the bonus years, but they all depend upon two things – God's part and your part.  No question that God will come through with His part.  The question is, will you and I come through with our part and ultimately that depends on how well prepared you are. And, seventh and last, retirement is not death – we have 100-percent probability on that.  Retirement has four major problems attached to it.  The first of which is income – the financial component; the second of which is health – the physical component; the third of which is housing, your living arrangements; but the fourth and the most important is purpose, meaning – and interest in life.  And the fascinating thing to me, and all the research proves it, is we're making tremendous progress in the first three but substantially none in the fourth, because it's the least recognized, and it's the most neglected. [end audio clip] Bob:                That's Dr. Howard Hendricks talking about some of the challenges that come with aging, specifically the issue of retirement.  It sounds like he could write "The Purpose-Driven Retirement," huh?  I think there's a hit book there for him. Dennis:          I think there is.  You know, what he's challenging us to do is to not think about our retirement in a worldly way, but to think about it in a spiritual, in a biblical way.  And our listeners are going to hear a series later on this spring, as Barbara and I talk about moving from the empty nest into what we are calling "prime time," and I think retirement needs to be prime time.  We need to have that purpose that Dr. Hendricks was talking about.  We need to have realigned our lives in light of the mission God has for us, and we need to get on with life.  We need to be about His work on this planet, because the person who has unplugged from their vocation has some additional time, theoretically, to be able to invest in some eternal pursuits that he may have never had in his or her life before. And I think knowing your purpose, knowing your mission, knowing what your life is all about, is very important, and I'd like to submit to you that Homebuilders, a small group Bible study, ought to be a very attractive ministry for a lot of couples who are moving into this phase of life, into prime time, and they are needing to sink their teeth into something purposeful – something that's going to make a difference for future generations.  Homebuilders is a small-group Bible study that I think can be used in the lives of young couples who are starting out their marriages, their families, and who are going through their own seasonal changes in their family who need help from an older generation. Bob:                And you're thinking that young couples would want to hear what a retired couple has to say about marriage? Dennis:          Absolutely.  I'm younger than some folks who are in this phase right now who are speaking truth and speaking vision and modeling certain realities to me, as a man.  I think all of us ought to have others who are a lap or two ahead of us in the race of life, who can guide us and direct us and make sure we don't waste any of our lives. Bob:                Retirement is not a move from productivity and work and meaning to leisure and enjoyment and recreation.  It's a move from one set of priorities to a new set of spiritual priorities, a new set of spiritual goals that you now have some free time for that you didn't have when you had to punch the clock every day. Dennis:          That's right, and that's why I'd suggest Homebuilders, which is very easy to lead, and I think most folks who are in this phase of life, the prime times of their lives, have the place – they've got a living room that's empty.  There's not any children running around, very few interruptions and, frankly, a lot of couples need to get away from their children for an evening occasionally and hear the biblical blueprints for building a marriage or a family. Bob:                Well, we've got the information, as you would imagine, about Homebuilders on our website at FamilyLife.com.  You can get more information about how easy it is to start one of these groups.  Get some other couples to join with you and experience the fun but also the purpose and the meaning that's wrapped up in being in a Homebuilders group.  Go to FamilyLife.com, or if you want to call 1-800-FLTODAY, someone on our team can give you more information about Homebuilders and how you can get involved in that growing movement of small groups all across the country.                         We also have Dr. Hendricks' message as part of a three-message series on either cassette or CD.  You can call 1-800-FLTODAY to request that series.  That's 1-800-F-as-in-family, L-as-in-life, and then the word TODAY.   Dennis:          Order two copies of this three-CD series – one for yourself and one for your parents – maybe three copies – one for your in-laws.  I just think there's a lot of sloppy thinking when it comes to retirement and what ought to be the prime time of our lives and, frankly, here is a man who is in his 80s – very vigorous, very alive in spite of battling cancer, who is showing us how to finish strong. Bob:                Well, again, go to our website at FamilyLife.com or call 1-800-FLTODAY for more information on the series of tapes or CDs from Dr. Howard Hendricks.  And then let me encourage you to also get a copy of John Piper's book, "Don't Waste Your Life."  A lot of people think that's a book for young people who are just starting out, and I remember Dr. Piper begins the book by talking about a retired couple that moved to Florida and collected seashells.  Do you remember that story? Dennis:          I do. Bob:                His whole premise is you can waste your life no matter what age you are, and you can also have a meaning and purpose for your life at any stage, at any age.  We have copies of that book in our FamilyLife Resource Center as well.                         Again, our website is FamilyLife.com.  If you want to call, the toll-free number is 1-800-F-as-in-family, L-as-in-life, and then the word TODAY.                         Let me say a quick word of thanks to the many folks who have joined with us here at FamilyLife as Legacy Partners.  These are the folks who, on a monthly basis, help provide the financial support for our ministry.  You know, in December we had a lot of folks who wrote to us and who made year-end contributions, and we appreciate all of you who did that, but there's also that group who keeps in mind that we have bills come due in January, and these are the folks who, each month, send a donation of $25 or $30, $50, $100 a month to help support the ongoing ministry of FamilyLife Today. Dennis:          And I'd like to encourage you, if you've been ministered to by the ministry of FamilyLife, would you stand with Bob and me here on FamilyLife Today?  Our Legacy Partners are real difference-makers.  They keep us going. Bob:                You can find out more about becoming a Legacy Partner, again, on our website at FamilyLife.com or just give us a call at 1-800-FLTODAY and say, "Tell me more about this Legacy Partner thing," and someone on our team would be happy to help you understand how you can join the growing team of folks who help make FamilyLife Today possible.                         Well, tomorrow we're going to hear part two of Dr. Hendricks' message on retirement, and I hope you can tune in.  I hope you can call somebody who may be retired or retiring and invite them to tune in for part two of this message as well.                         I want to thank our engineer today, Keith Lynch, and our entire broadcast production team.  On behalf of our host, Dennis Rainey, I'm Bob Lepine.  We'll see you back tomorrow for another edition of FamilyLife Today.                          FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ.  ________________________________________________________________ We are so happy to provide these transcripts to you.  However, there is a cost to transcribe, create, and produce them for our website.  If you've benefited from the broadcast transcripts, would   you consider donating today to help defray the costs?         Copyright © FamilyLife.  All rights reserved. www.FamilyLife.com

Dr. Christine Schaffner speaks with Bunnie Gulick, the founder of ISUN Organic Skincare, about what she's done over the last 40 years to maintain such a vibrant look. They also talk about Bunnie's journey to creating the ISUN Organic Skincare line. If you're interested in checking out ISUN, then you should visit bellafioreorganics.com! That's Dr. Schaffner's new online store - you can get everything you need there. Check it out! For more Dr. Schaffner (including more podcasts!), visit www.drchristineschaffner.com.